ACL Tear Treatment Options

Treatment for ACL tears typically falls into two categories: conservative nonsurgical management and surgical reconstruction. The choice of treatment depends on the severity of the tear, the patient’s activity level, and their long-term goals.

Nonsurgical management is generally reserved for patients with partial ACL tears, lower activity levels, or those who are not candidates for surgery due to medical or personal reasons. Non-surgical approaches focus on:

Physical Therapy

Physical therapy is the cornerstone of conservative management. A structured rehabilitation program aims to restore knee strength, stability, and range of motion. Therapists work with patients to build the surrounding muscles, particularly the quadriceps and hamstrings, to compensate for the compromised ligament.

Bracing

Functional knee braces can provide additional support during daily activities and low-impact sports. Braces are often used in conjunction with therapy to enhance stability and prevent further injury.

Activity Modification

For patients with sedentary or less physically demanding lifestyles, avoiding high-impact activities can reduce the risk of instability episodes or additional damage to the knee.

While nonsurgical management can be effective in some cases, it is not ideal for individuals with high activity levels or those whose knees exhibit persistent instability.

For patients who wish to return to sports or whose knee feels unstable despite nonsurgical interventions, ACL reconstruction is the gold-standard treatment.

Arthroscopic ACL Reconstruction

Dr. Boden specializes in minimally invasive arthroscopic techniques, which involve small incisions and the use of a camera to visualize the knee joint. During the procedure, the torn ligament is replaced with a graft, which serves as the foundation for a new ligament to form.

Graft Choices

Several graft options are available, and the choice is tailored to the patient’s age, activity level, and specific needs:

• An Autograft is tissue harvested from the patient, such as the patellar tendon, hamstring tendon, or quadriceps tendon. Autografts are often preferred for younger, active patients due to their robust healing properties.
• An Allograft is tissue sourced from a donor. Allografts may be recommended for older or less active patients to reduce post-operative pain and recovery time.

ACL Repair

In select cases, ACL repair may be considered instead of reconstruction. The ability to repair the ACL depends on several factors, including the tear extent, location, tissue quality, and timing of surgery. Dr. Boden specializes in minimally invasive arthroscopic techniques that allow for repair of the ACL without graft harvest, allowing for smaller incisions, preservation of native tissue, and improved proprioception after repair.

Advanced Open Reconstruction

In complex cases, such as high-risk patients, multi-ligament injuries, or revisions of prior ACL surgeries, Dr. Boden may employ advanced open reconstruction techniques to ensure optimal outcomes. This may include a lateral extra-articular tenodesis (LET) to help stabilize the knee joint and reduce the risk of ACL re-tear.

Recovering from an ACL injury, whether treated nonsurgically or surgically, requires a well-structured rehabilitation plan. Dr. Boden emphasizes the importance of individualized care to ensure patients regain full function and achieve their personal goals.

Post-Surgical Recovery Timeline

• Immediate Post-Operative Period (Weeks 1-2) – Following ACL reconstruction, the focus is on reducing pain and swelling while regaining knee extension. Cryotherapy and compression are commonly used, along with gentle range-of-motion exercises. Physical therapy is started right away to allow for optimal knee range of motion and quadriceps re-activation.
• Early Rehabilitation (Weeks 3-6) – During this phase, physical therapy emphasizes restoring range of motion and improving quadriceps strength. Patients may progress weight-bearing activities with the guidance of their surgeon and therapist.
• Intermediate Rehabilitation (Weeks 7-12) – As strength improves, patients progress to more challenging exercises that target balance, proprioception (position, movement and balance), and functional strength. Exercises include squats, lunges, and step-ups to mimic daily activities and sports-specific movements.
• Advanced Rehabilitation (Months 3-6) – Patients gradually return to higher-impact activities, including light jogging and sport-specific drills. Emphasis is placed on neuromuscular control to reduce the risk of re-injury.
• Return to Sport (6-12 Months) – Return to sport functional testing can be performed at 6 months to allow for a patient-specific rehabilitation plan. Full return to sport is typically permitted around the 9 to 12 months, depending on the patient’s progress. Dr. Boden collaborates closely with therapists and trainers to ensure a safe and successful return to play.

The key to a successful recovery is:

1. Consistent participation in physical therapy
2. Focusing on hip, core, and lower extremity strength to reduce strain on the knee joint.
3. Avoiding premature return to high-impact activities helps prevent complications.