About 200,000 ACL injuries occur every year in the United States. Adolescents, females and athletes in pivoting/cutting sports like soccer or basketball tend to have more ACL injuries. There are many physicians and facilities that can repair an ACL tear, but only Dayton Children's orthopedic and sports medicine center offers cutting edge, compassionate care from diagnosis, to treatment to prevention.
treating an ACL injury
When the ACL is torn it does not heal on its own, and the knee becomes unstable. Without the ACL controlling knee movement, the knee bones are more likely to rub against each other with activity. This leads to injuries of the tissue that covers the ends of the bones (cartilage), and can trap and tear the pads that cushion the knee joint (meniscus). The doctor will want to do some imaging tests to see the injury. These tests can include X-rays and/or a CT scan or MRI. The radiologist and orthopedic surgeon will carefully review the images from the tests to see the extent of the injury. Then, the surgeon will discuss with you and your child the best treatment option based on age, lifestyle and future goals. This could include surgery. If the ACL is partially torn, sometimes these can be repaired or rehabilitated. However, 90 percent of ACL injuries usually go on to need replacement or reconstruction, followed by physical therapy and bracing.
One of the major causes of pain following a knee injury is the fluid and blood within the knee joint. The knee often appears swollen with limited motion and weight bearing is either painful or impossible. Crutches may be used temporarily in addition to a brace to keep the leg from moving (immobilization) to help stabilize the knee and reduce pain. Swelling responds well to the acronym RICE:
We also encourage anti-inflammatories (naproxen, ibuprofen) in the initial injury phase to help reduce inflammation. Hydrocodone, a narcotic, may also be prescribed by your provider for breakthrough pain. But in many cases, we wait to prescribe it until after surgery. Your doctor will discuss how often you should use your knee immobilizer and crutches based on other injuries you may have.
Before surgery, we will work with your child in prehabilitiation (pre-surgery rehab) to return their knee back to the size and strength they had before their injury. Research shows that this helps better prepare the knee for surgery. A few visits with our physical therapists are also very important to help reduce pain. The main goals of prehab are preparing the knee for surgery by reducing the joint effusion, regaining knee motion and working on the muscles in the upper thigh (quadriceps). Meeting these goals is important for the best timing of surgery.
The ACL is the most commonly injured ligament in athletes. Over 150,000 ACL surgeries are performed annually in the United States. There are a few different ways to perform reconstruction of a torn ACL. Our experienced orthopaedic surgeons discuss all surgical cases weekly and work together to stay current in the best techniques and practices.
The main goal of ACL reconstruction is to recreate a safe, stable knee by placing a “new” ACL in the position for your body. The “new” ACL, or graft, may be taken from the patient (autograft), or it may be a prepared cadaveric tendon (allograft). Allografts are not a preferred choice for athletes that participate in contact sports. Different types of grafts are used for ACL reconstruction. Your surgeon will carefully evaluate your child’s knee and will take into account their age, whether they are finished growing, their level of sports participation and their future athletic goals to recommend the best graft. We perform many types of ACL surgeries for young children:
- For patients 10 and younger: Physeal sparing surgery
- For females 10-12 years old and males 13 and younger: Ephyseal approach
- For patents who are finished or nearly finished growing: Adult type ACL reconstruction. These include:
- Hamstring tendon
- Quadriceps tendon
Your surgeon will discuss with you the best surgical option for your child, taking into consideration their age, anatomy, what structures need to be addressed and activity/athletic level. Other injuries may need to be repaired as well, such as meniscal tears or cartilage damage. Your surgeon will discuss the repair of these injuries and their possible impact on rehabilitation.
rehab and return to sports
The return to sports timeframe for ACL reconstruction is different for each patient and is based on several factors. These factors include:
- The type of surgery
- What sport(s) the athlete is involved in
- Progress with rehabilitation
- Knee stability
- Objective testing
The minimum return to play (supported by numerous research articles) is nine months. Many researchers recommend a 12-24 month wait before return to play. We take a comprehensive team approach to allowing patients to return to sports. Physical therapists, your surgeon, parents and coaches will all be involved in assuring the safest return to sports. Nationally, the average rate of re-injury after ACL reconstruction is 30 percent. This is why taking time to heal properly is so important.
ACL bridge program and prevention training
As part of your child’s recovery, they will likely go through the Sportsmetrics™ training program run by our athletic trainers and physical therapists. Sportsmetrics is a scientifically proven, six-week jump training program that incorporates proper stretching, special plyometric exercises and weight training. It focuses on developing overall leg strength as well as improving balance in strength from the front to the back of the thigh.
Athletes do 12 to 18 one-hour sessions challenging their bodies to execute jumps, cone and footwork drills and core strengthening all while gaining positive feedback from an athletic trainer. Student to teacher ratios are kept to 6 to 1 or better to make sure each athlete receives personalized recommendations and attention. Through specialized progression of jump/plyometric drills, athletes learn proper techniques for jumping and landing; increase overall leg strength and improve symmetry in right-to-left leg power. Each session builds on the previous one, developing technique and enhancing performance.
Neuromuscular training not only increases muscular power and jump height, but also decreases stress and impact at the knee. The strength and flexibility components have been carefully reviewed for safety and effectiveness. Our ACL Bridge Sportsmetrics program is specifically designed for athletes returning to play after ACL reconstruction.