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When to Seek Treatment for Common ACL Tears

in ACL, Knee, Knee Injuries, Knee Pain

Article featured on The Noyes Knee Institute

If you experience pain around your knee area, it is advisable to contact an orthopedic knee surgeon as soon as possible. The pain may stem from a torn anterior cruciate ligament (ACL). Such situations may call for surgery to prevent further damage to your knee joint.

The ACL is one of four ligaments in your knee. It is located behind the patella (kneecap) and connects the thigh bone to the shin bone. The posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) are the other three ligaments.

ACL Tear Symptoms

ACL stabilizes the knee when you rotate and can get torn when you make sudden stops or changes in direction. Injuries can also result from high-impact sports and maneuvers such as jumping and landing. A torn ACL has many signs, depending on the severity of the injury. Popular symptoms include:

1. Popping Sounds

A loud popping sound is the most common symptom of a torn anterior cruciate ligament. You will hear the popping sound at the moment of injury. Silent pops may also occur when you try to stand or move the knee joint. ACL tears can also result in a painful grinding feeling of your kneecap and bones.

2. Pain and Swelling

A popping sound may indicate other issues but is often a result of torn ACL, especially when accompanied by pain and swelling. The pain is severe at the moment of injury and becomes sharper when you try to get up or put pressure on the knee. In most cases, the pain is quickly accompanied by inflammation/swelling of the knee area.

3. Inability to Bear Weight

You will barely be able to stand a few minutes after an ACL tear. The anterior cruciate ligament is responsible for stabilizing your knee when you move or change directions. Tears in the band of tissue compromise this function, making it difficult to bear your weight or continue with any activity.

4. Lost Range of Motion

ACL tears can result in loss of range of motion, making it impossible to bend, walk, or sprint. Lost range of motion usually stems from excruciating pain. Your knee surgeon will test the range of motion to determine the severity of your pain and injury. Regaining range of motion is also a good sign during ACL tear recovery.

When to Seek Treatment

The knee is one of the most complex joints and harbors ligaments, tendons, tissues, and bones. It is crucial to seek a medical diagnosis immediately if you experience the symptoms of an ACL tear. Proper diagnosis will reveal the scale of injury and determine the best remedy.

Some cases can resolve with rest and rehabilitation. Others require medication, physical therapy, or surgery to remove the damaged parts. Diagnosis involves reviewing your medical history and symptom patterns.

The physician will also conduct a physical examination and may use X-ray scans or request an MRI to assess damage to bones, cartilage, and menisci. After diagnosis, the knee doctor will determine whether you need non-surgical or surgical treatment.

Working With an Orthopedic Knee Surgeon

The first assessment will determine if knee surgery is essential. If such is the recommendation, you should immediately seek an experienced orthopedic knee surgeon. There are various types of surgeries used to treat ACL tears.


New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2023/03/Blog-header-image-when-to-seek-treatment-for-common-ACL-tears-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2023-03-14 12:00:132023-03-14 12:00:13When to Seek Treatment for Common ACL Tears

After ACL Surgery

in ACL
Article featured on UCSF Health

See our recommendations for helping your knee recover (and when to call the doctor) after surgery. Find out what to expect from your rehab program, when you’re likely to start walking, and when it’s safe to start swimming and running.

Recovery from ACL Surgery

After anterior cruciate ligament (ACL) surgery, move your ankles up and down an average of 10 times every 10 minutes. Continue this exercise for two to three days to help blood circulation and to prevent blood clots from forming in your legs. If you develop acute pain in the back of your calf, tell your doctor. This could be an early sign of clots.

Elevate leg

Keep your operated leg elevated at a minimum of a 45-degree angle. Prop your leg on cushions or pillows so your knee is at least 12 inches above your heart for the first three to five days after surgery. Keep your leg elevated if your knee swells or throbs when you are up and about on crutches. Don’t put pillows behind your knee because this limits motion of the knee. Place pillows under your heel and calf.

Take pain medication

Expected pain and discomfort for the first few days. Take pain medications as your doctor advises. These could be over-the-counter painkillers, such as ibuprofen or acetaminophen, or stronger narcotic drugs.

Bend knee

Slowly begin bending your knee. Straighten your leg and bend your knee. If necessary, place your hands behind your knee for assistance bending your knee. The goal is to achieve a range of motion of 0 to 90 degrees by the time you return for your first post-operative visit a week after surgery.

Monitor for fever

A low-grade fever – up to 101 degrees Fahrenheit or 38.3 Celsius – is common for four or five days after surgery. If your temperature is higher or lasts longer, tell your doctor. Your temperature should go down with acetaminophen.

Remove bandage

The dressing on your knee is usually removed the day after surgery. There may be some minor fluid drainage for two days. Sterile dressings or bandages may be used during this time. After surgery, keep the wound clean and dry. Take sponge baths until the sutures are removed.

Rehabilitation

Your rehabilitation program to restore range of motion to your knee begins the moment you wake up in the recovery room. During the first week after surgery, most patients are encouraged to lift their legs without assistance while lying on their backs. These are called straight leg raises. By the end of the second or third week, patients usually walk without crutches.
Sessions with a physical therapist usually begin seven to 14 days after surgery. During physical therapy, weight bearing is allowed if you did not have a meniscus repair.
A range of motion of 0 to 140 degrees is a good goal for the first two months.
Don’t work your quadriceps early on because this can stretch the ACL graft. Stationery bike riding or lightweight leg presses are recommended during the first three months after surgery. These exercises strengthen the quadriceps while using the hamstrings to protect the ACL graft.
Don’t swim or run for five months. You can swim with your arms, without paddling your feet, at about two to three months after surgery.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2021/12/Blog-header-image-life-after-acl-surgery-NMO-in-New-Mexico.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2021-12-22 12:00:102021-12-22 12:00:10After ACL Surgery
Frequently Asked Questions about Knee Pain

Frequently Asked Questions about Knee Pain

in ACL, Knee, Knee Injuries, Knee Pain

Article Featured on WebMD

Your knee hurts and you want to know why. Whether it’s an injury or arthritis, here are answers from an orthopedic surgeon who specializes in sports medicine and knee care.

Could my pain be from osteoarthritis?

Yes. Probably 95% of knee pain caused by arthritis is osteoarthritis, which is caused by “wear and tear” on the joints. Other types, like rheumatoid arthritis, are much less common causes of knee pain.

What kind of injuries can cause knee pain?

They’re usually twisting injuries to the knee: ACL, meniscus, or ligament injuries.

What’s the difference?

The main difference between arthritis and other kinds of knee pain is there’s no trauma associated with it. A person who tore their ACL or had a meniscus injury knows exactly when it happened. With arthritis, it’s more of a dull, aching pain. It gets worse as time goes on.

Will my pain go away on its own?

It depends. Arthritis pain tends to wax and wane over time. It may not completely go away, but sometimes it feels much better. Pain from an injury improves at first, but if you’re left with a sore joint, you may not be able to do certain activities.

When do I need to see a doctor?

Everyone has a different pain threshold. If you’ve an injury and your knee swells, you need to see your doctor. Even if the swelling goes away, you need to have your knee examined — you might have injured something inside the joint. If you have arthritis pain and the bad days outnumber the good, you should see your doctor.

How do I keep my knees healthy?

I think weight control is important. Flexibility helps as well. If you take part in a sport that requires a lot of physical exertion, like skiing or tennis or soccer, you need to get in shape.

Also, when you get tired, you need to stop. Look at the rate of knee injury: It goes up in the fourth quarter or final period of a game. Just a millisecond or two of delay of muscle function can cause injury. If the muscles that protect the ligament are tired, they don’t do a good job.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2020/06/Frequently-Asked-Questions-about-Knee-Pain.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2020-06-05 14:30:552020-06-05 14:30:55Frequently Asked Questions about Knee Pain
ACL Tears: Not Just For Athletes

ACL Tears: Not Just For Athletes

in ACL

Article Featured on OSMSGB

With so many high-profile, professional athletes overcoming ACL tears, it’s becoming well-known that this is one of the most common sports-related injuries. However, what may be less understood is that ACL tears don’t just affect professional or competitive athletes.

Understanding ACL Tears

The anterior cruciate ligament (ACL) is one of four ligaments that helps ensure stability in the knee and proper movement. The main causes of an ACL tear include:

  • Pivoting or changing direction quickly
  • Making a sudden stop
  • Landing from a jump incorrectly

For these reasons, it makes sense that football, basketball and soccer are sports that see this injury a lot. But when you think about everyday life, many activities also involve these movements:

  • Running after and playing with your kids
  • Trying a new cardio-fitness class
  • Jumping on a trampoline

Plus, as we age, changes in the ACL, previous knee injuries and reduced strength can also increase the risk for a tear from something as simple as stepping in a hole.

For a professional or competitive athlete, the loud pop, sudden instability and immediate swelling of an ACL tear could be a season-ending injury. But what does it mean for a moderately active adult?

Sandy’s Story

Sandy Fragale has been the administrator at Orthopedic & Sports Medicine Specialists of Green Bay (OSMS) for 15 years, so she is familiar with ACL tears. However, when she was at a trampoline park in November 2015 with family and friends, her ACL was the last thing on her mind.

Until, she suddenly went down.

“As soon as I landed and fell, I knew I injured something,” she says. “It felt like my skin tore.”

Sandy needed help to get off the trampoline, but she walked out to the car by herself. The next day, she saw an orthopedic physician at OSMS. During her exam, as the doctor was easily able to push her knee back and forth, it was pretty clear that Sandy had torn her ACL. And an MRI confirmed it.

The next step – deciding if surgery was the best treatment option.

“Surgical reconstruction is determined by a number of factors, including a patient’s past, current and desired activity level,” says Dr. Thomas Sullivan, an orthopedic surgeon at OSMS. “With an ACL tear, surgery doesn’t have to happen immediately, so patients can schedule it to fit into their lives. In fact, we won’t perform the surgery until all the swelling has disappeared, which typically takes a couple weeks.”

While Sandy is no longer a competitive athlete, she is still a very active person. That’s one reason why she chose to have surgery.

“I didn’t want to be limited long-term in the activities I could do, like skiing or playing beach volleyball on vacation,” Sandy says. “And I knew not fixing it could lead to an earlier development of arthritis.”

Since Sandy’s initial injury happened right around Thanksgiving, she decided to wait and have her surgery in January to avoid taking time off of work during the busy end-of-year or missing out on holiday fun with her family.

Sandy’s post-surgery results:

  • Within three days, she was off pain medications.
  • Her leg was immediately weight-bearing.
  • She went back to work in just one week.
  • Now, eight-weeks post-surgery, she has no pain, full range of motion in her knee and is able to use the elliptical, treadmill, bike and lift weights.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2020/03/ACL-Tears-Not-Just-For-Athletes.jpg 300 833 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2020-03-13 23:56:152020-03-13 23:56:15ACL Tears: Not Just For Athletes
Does an ACL Injury Require Surgery

Does an ACL Injury Require Surgery

in ACL, Surgery

The following article provides in-depth information about treatment for anterior cruciate ligament injuries. The general article, Anterior Cruciate Ligament (ACL) Injuries, provides a good introduction to the topic and is recommended reading prior to this article.

The information that follows includes the details of anterior cruciate ligament (ACL) anatomy and the pathophysiology of an ACL tear, treatment options for ACL injuries along with a description of ACL surgical techniques and rehabilitation, potential complications, and outcomes. The information is intended to assist the patient in making the best-informed decision possible regarding the management of ACL injury.

Anatomy

normal knee anatomy

Normal knee anatomy.  The knee is made up of four main things: bones, cartilage, ligaments, and tendons.

The bone structure of the knee joint is formed by the femur, the tibia, and the patella. The ACL is one of the four main ligaments within the knee that connect the femur to the tibia.

The knee is essentially a hinged joint that is held together by the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL) ligaments. The ACL runs diagonally in the middle of the knee, preventing the tibia from sliding out in front of the femur, as well as providing rotational stability to the knee.

The weight-bearing surface of the knee is covered by a layer of articular cartilage. On either side of the joint, between the cartilage surfaces of the femur and tibia, are the medial meniscus and lateral meniscus. The menisci act as shock absorbers and work with the cartilage to reduce the stresses between the tibia and the femur.

Description

ACL tear

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee.  In general, the incidence of ACL injury is higher in people who participate in high-risk sports, such as basketball, football, skiing, and soccer.

Approximately half of ACL injuries occur in combination with damage to the meniscus, articular cartilage, or other ligaments. Additionally, patients may have bruises of the bone beneath the cartilage surface. These may be seen on a magnetic resonance imaging (MRI) scan and may indicate injury to the overlying articular cartilage.

arthroscopic images of normal ACL and ACL tear

(Left) Arthroscopic picture of the normal ACL. (Right) Arthroscopic picture of torn ACL [yellow star].

Cause

It is estimated that the majority of  ACL injuries occur through non-contact mechanisms, while a smaller percent result from direct contact with another player or object.

The mechanism of injury is often associated with deceleration coupled with cutting, pivoting or sidestepping maneuvers, awkward landings or “out of control” play.

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other hypothesized causes of this gender-related difference in ACL injury rates include pelvis and lower extremity (leg) alignment, increased ligamentous laxity, and the effects of estrogen on ligament properties.

Doctor Examination

Immediately after the injury, patients usually experience pain and swelling and the knee feels unstable. Within a few hours after a new ACL injury, patients often have a large amount of knee swelling, a loss of full range of motion, pain or tenderness along the joint line and discomfort while walking.

When a patient with an ACL injury is initially seen for evaluation in the clinic, the doctor may order x-rays to look for any possible fractures. He or she may also order a magnetic resonance imaging (MRI) scan to evaluate the ACL and to check for evidence of injury to other knee ligaments, meniscus cartilage, or articular cartilage.

MRI of ACL tear

An MRI of a complete ACL tear. The ACL fibers have been disrupted and the ACL appears wavy in appearance [yellow arrow].

In addition to performing special tests for identifying meniscus tears and injury to other ligaments of the knee, the physician will often perform the Lachman’s test to see if the ACL is intact.

If the ACL is torn, the examiner will feel increased forward (upward or anterior) movement of the tibia in relation to the femur (especially when compared to the normal leg) and a soft, mushy endpoint (because the ACL is torn) when this movement ends.

Natural History

What happens naturally with an ACL injury without surgical intervention varies from patient to patient and depends on the patient’s activity level, degree of injury and instability symptoms.

The prognosis for a partially torn ACL is often favorable, with the recovery and rehabilitation period usually at least 3 months. However, some patients with partial ACL tears may still have instability symptoms. Close clinical follow-up and a complete course of physical therapy helps identify those patients with unstable knees due to partial ACL tears.

Complete ACL ruptures have a much less favorable outcome without surgical intervention. After a complete ACL tear, some patients are unable to participate in cutting or pivoting-type sports, while others have instability during even normal activities, such as walking. There are some rare individuals who can participate in sports without any symptoms of instability. This variability is related to the severity of the original knee injury, as well as the physical demands of the patient.

About half of ACL injuries occur in combination with damage to the meniscus, articular cartilage or other ligaments. Secondary damage may occur in patients who have repeated episodes of instability due to ACL injury. With chronic instability, a large majority of patients will have meniscus damage when reassessed 10 or more years after the initial injury. Similarly, the prevalence of articular cartilage lesions increases in patients who have a 10-year-old ACL deficiency.

Nonsurgical Treatment

In nonsurgical treatment, progressive physical therapy and rehabilitation can restore the knee to a condition close to its pre-injury state and educate the patient on how to prevent instability. This may be supplemented with the use of a hinged knee brace. However, many people who choose not to have surgery may experience secondary injury to the knee due to repetitive instability episodes.

Surgical treatment is usually advised in dealing with combined injuries (ACL tears in combination with other injuries in the knee). However, deciding against surgery is reasonable for select patients. Nonsurgical management of isolated ACL tears is likely to be successful or may be indicated in patients:

  • With partial tears and no instability symptoms
  • With complete tears and no symptoms of knee instability during low-demand sports who are willing to give up high-demand sports
  • Who do light manual work or live sedentary lifestyles
  • Whose growth plates are still open (children)

Surgical Treatment

ACL tears are not usually repaired using suture to sew it back together, because repaired ACLs have generally been shown to fail over time. Therefore, the torn ACL is generally replaced by a substitute graft made of tendon.

  • Patellar tendon autograft (autograft comes from the patient)
  • Hamstring tendon autograft
  • Quadriceps tendon autograft
  • Allograft (taken from a cadaver) patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon

Patient Considerations

Active adult patients involved in sports or jobs that require pivoting, turning or hard-cutting as well as heavy manual work are encouraged to consider surgical treatment. This includes older patients who have previously been excluded from consideration for ACL surgery. Activity, not age, should determine if surgical intervention should be considered.

In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The surgeon can delay ACL surgery until the child is closer to skeletal maturity or the surgeon may modify the ACL surgery technique to decrease the risk of growth plate injury.

A patient with a torn ACL and significant functional instability has a high risk of developing secondary knee damage and should therefore consider ACL reconstruction.

It is common to see ACL injuries combined with damage to the menisci, articular cartilage, collateral ligaments, joint capsule, or a combination of the above. The “unhappy triad,” frequently seen in football players and skiers, consists of injuries to the ACL, the MCL, and the medial meniscus.

In cases of combined injuries, surgical treatment may be warranted and generally produces better outcomes. As many as half of meniscus tears may be repairable and may heal better if the repair is done in combination with the ACL reconstruction.

Surgical Choices

Patellar tendon autograft prepared for ACL reconstruction

Patellar tendon autograft prepared for ACL reconstruction.

Patellar tendon autograft. The middle third of the patellar tendon of the patient, along with a bone plug from the shin and the kneecap is used in the patellar tendon autograft. Occasionally referred to by some surgeons as the “gold standard” for ACL reconstruction, it is often recommended for high-demand athletes and patients whose jobs do not require a significant amount of kneeling.

In studies comparing outcomes of patellar tendon and hamstring autograft ACL reconstruction, the rate of graft failure was lower in the patellar tendon group. In addition, most studies show equal or better outcomes in terms of postoperative tests for knee laxity (Lachman’s, anterior drawer and instrumented tests) when this graft is compared to others. However, patellar tendon autografts have a greater incidence of postoperative patellofemoral pain (pain behind the kneecap) complaints and other problems.

The pitfalls of the patellar tendon autograft are:

  • Postoperative pain behind the kneecap
  • Pain with kneeling
  • Slightly increased risk of postoperative stiffness
  • Low risk of patella fracture

Hamstring tendon autograft. The semitendinosus hamstring tendon on the inner side of the knee is used in creating the hamstring tendon autograft for ACL reconstruction. Some surgeons use an additional tendon, the gracilis, which is attached below the knee in the same area. This creates a two- or four-strand tendon graft. Hamstring graft proponents claim there are fewer problems associated with harvesting of the graft compared to the patellar tendon autograft including:

  • Fewer problems with anterior knee pain or kneecap pain after surgery
  • Less postoperative stiffness problems
  • Smaller incision
  • Faster recovery

Hamstring tendon autograft prepared for ACL reconstruction

Hamstring tendon autograft prepared for ACL reconstruction.

The graft function may be limited by the strength and type of fixation in the bone tunnels, as the graft does not have bone plugs. There have been conflicting results in research studies as to whether hamstring grafts are slightly more susceptible to graft elongation (stretching), which may lead to increased laxity during objective testing. Recently, some studies have demonstrated decreased hamstring strength in patients after surgery.

There are some indications that patients who have intrinsic ligamentous laxity and knee hyperextension of 10 degrees or more may have increased risk of postoperative hamstring graft laxity on clinical exam. Therefore, some clinicians recommend the use of patellar tendon autografts in these hypermobile patients.

Additionally, since the medial hamstrings often provide dynamic support against valgus stress and instability, some surgeons feel that chronic or residual medial collateral ligament laxity (grade 2 or more) at the time of ACL reconstruction may be a contraindication for use of the patient’s own semitendinosus and gracilis tendons as an ACL graft.

Quadriceps tendon autograft. The quadriceps tendon autograft is often used for patients who have already failed ACL reconstruction. The middle third of the patient’s quadriceps tendon and a bone plug from the upper end of the knee cap are used. This yields a larger graft for taller and heavier patients. Because there is a bone plug on one side only, the fixation is not as solid as for the patellar tendon graft. There is a high association with postoperative anterior knee pain and a low risk of patella fracture. Patients may find the incision is not cosmetically appealing.

Allografts. Allografts are grafts taken from cadavers and are becoming increasingly popular. These grafts are also used for patients who have failed ACL reconstruction before and in surgery to repair or reconstruct more than one knee ligament. Advantages of using allograft tissue include elimination of pain caused by obtaining the graft from the patient, decreased surgery time and smaller incisions. The patellar tendon allograft allows for strong bony fixation in the tibial and femoral bone tunnels with screws.

However, allografts are associated with a risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing. Several deaths linked to bacterial infection from allograft tissue (due to improper procurement and sterilization techniques) have led to improvements in allograft tissue testing and processing techniques. There have also been conflicting results in research studies as to whether allografts are slightly more susceptible to graft elongation (stretching), which may lead to increased laxity during testing.

Some published literature may point to a higher failure rate with the use of allografts for ACL reconstruction. Higher failure rates for allografts have been reported in young, active patients returning to high-demand sporting activities after ACL reconstruction, compared with autografts.

The reason for this higher failure rate is unclear. It could be due to graft material properties (sterilization processes used, graft donor age, storage of the graft). It could possibly be due to an ill-advised earlier return to sport by the athlete because of a faster perceived physiologic recovery, when the graft is not biologically ready to be loaded and stressed during sporting activities. Further research in this area is indicated and is ongoing.

Surgical Procedure

Before any surgical treatment, the patient is usually sent to physical therapy. Patients who have a stiff, swollen knee lacking full range of motion at the time of ACL surgery may have significant problems regaining motion after surgery. It usually takes three or more weeks from the time of injury to achieve full range of motion. It is also recommended that some ligament injuries be braced and allowed to heal prior to ACL surgery.

The patient, the surgeon, and the anesthesiologist select the anesthesia used for surgery. Patients may benefit from an anesthetic block of the nerves of the leg to decrease postoperative pain.

The surgery usually begins with an examination of the patient’s knee while the patient is relaxed due the effects of anesthesia. This final examination is used to verify that the ACL is torn and also to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed postoperatively.

If the physical exam strongly suggests the ACL is torn, the selected tendon is harvested (for an autograft) or thawed (for an allograft) and the graft is prepared to the correct size for the patient.

Passage of patellar tendon graft during ACL reconstruction

Passage of patellar tendon graft into tibial tunnel of knee.

After the graft has been prepared, the surgeon places an arthroscope into the joint. Small (one-centimeter) incisions called portals are made in the front of the knee to insert the arthroscope and instruments and the surgeon examines the condition of the knee. Meniscus and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed.

post-operative x-ray of ACL reconstruction

Post-operative X-ray after ACL patellar tendon reconstruction (with picture of graft superimposed) shows graft position and bone plugs fixation with metal interference screws.

In the most common ACL reconstruction technique, bone tunnels are drilled into the tibia and the femur to place the ACL graft in almost the same position as the torn ACL. A long needle is then passed through the tunnel of the tibia, up through the femoral tunnel, and then out through the skin of the thigh. The sutures of the graft are placed through the eye of the needle and the graft is pulled into position up through the tibial tunnel and then up into the femoral tunnel. The graft is held under tension as it is fixed in place using interference screws, spiked washers, posts, or staples. The devices used to hold the graft in place are generally not removed.

Variations on this surgical technique include the “two-incision,” “over-the-top,” and “double-bundle” types of ACL reconstructions, which may be used because of the preference of the surgeon or special circumstances (revision ACL reconstruction, open growth plates).

Before the surgery is complete, the surgeon will probe the graft to make sure it has good tension, verify that the knee has full range of motion and perform tests such as the Lachman’s test to assess graft stability. The skin is closed and dressings (and perhaps a postoperative brace and cold therapy device, depending on surgeon preference) are applied. The patient will usually go home on the same day of the surgery.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Rehabilitation

Physical therapy is a crucial part of successful ACL surgery, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient’s dedication to rigorous physical therapy. With new surgical techniques and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.

Postoperative Course. In the first 10 to 14 days after surgery, the wound is kept clean and dry, and early emphasis is placed on regaining the ability to fully straighten the knee and restore quadriceps control.

The knee is iced regularly to reduce swelling and pain. The surgeon may dictate the use of a postoperative brace and the use of a machine to move the knee through its range of motion. Weight-bearing status (use of crutches to keep some or all of the patient’s weight off of the surgical leg) is also determined by physician preference, as well as other injuries addressed at the time of surgery.

Rehabilitation. The goals for rehabilitation of ACL reconstruction include reducing knee swelling, maintaining mobility of the kneecap to prevent anterior knee pain problems, regaining full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles.

The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored.

The patient’s sense of balance and control of the leg must also be restored through exercises designed to improve neuromuscular control. This usually takes 4 to 6 months. The use of a functional brace when returning to sports is ideally not needed after a successful ACL reconstruction, but some patients may feel a greater sense of security by wearing one.

Surgical Complications

Infection. The incidence of infection after arthroscopic ACL reconstruction is very low.  There have also been reported deaths linked to bacterial infection from allograft tissue due to improper procurement and sterilization techniques.

Viral transmission. Allografts specifically are associated with risk of viral transmission, including HIV and Hepatitis C, despite careful screening and processing. The chance of obtaining a bone allograft from an HIV-infected donor is calculated to be less than 1 in a million.

Bleeding, numbness. Rare risks include bleeding from acute injury to the popliteal artery, and weakness or paralysis of the leg or foot. It is not uncommon to have numbness of the outer part of the upper leg next to the incision, which may be temporary or permanent.

Blood clot. Although rare, blood clot in the veins of the calf or thigh is a potentially life-threatening complication. A blood clot may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke.

Instability. Recurrent instability due to rupture or stretching of the reconstructed ligament or poor surgical technique is possible.

Stiffness. Knee stiffness or loss of motion has been reported by some patients after surgery.

Extensor mechanism failure. Rupture of the patellar tendon (patellar tendon autograft) or patella fracture (patellar tendon or quadriceps tendon autografts) may occur due to weakening at the site of graft harvest.

Growth plate injury. In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. The ACL surgery can be delayed until the child is closer to reaching skeletal maturity. Alternatively, the surgeon may be able to modify the technique of ACL reconstruction to decrease the risk of growth plate injury.

Kneecap pain. Postoperative anterior knee pain is especially common after patellar tendon autograft ACL reconstruction. The incidence of pain behind the kneecap varies greatly  in studies, whereas the incidence of kneeling pain is often higher after patellar tendon autograft ACL reconstruction.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

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ACL Injuries in Children and Adolescents

ACL Injuries in Children and Adolescents

in ACL, Sports Injuries, Sports Medicine

Article Featured on Nationwide Children’s

It has been frequently emphasized that children are not simply “small adults.” Children and adults are different anatomically and physiologically in many ways. Knee injuries in children and adolescents frequently demonstrate these differences.

Read more

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What to do with a torn ACL

What to do with a Torn ACL

in ACL

Article Featured on BetterBraces

Soccer, basketball and football athletes most often experience ACL injuries, with nearly 200,000 cases seen each year. While this injury is more frequently seen in women than men, reasons for which include differences in muscular strength, physical conditioning and neuromuscular control, the cause, pain and treatment is the same.

Learn about ACL injuries and become a more educated athlete so you know when to seek medical attention and can return to your sport as soon as possible.

WHAT IS IT?

ACL stands for anterior cruciate ligament; this ligament runs diagonally across in the middle of your knee and has a number of duties: “It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee,” according to the American Academy of Orthopaedic Surgeons.

When the ACL is injured, the surrounding ligaments and cartilage are often sprained as well. While the ACL could tear only partially, this is rare; more commonly there is a near complete or complete tear.

HOW DOES IT HAPPEN? WHAT CAUSES IT?

This injury is most common in athletes who play football, basketball and soccer for a reason-ACL tears happen as a result of rapid direction changes, improperly landing from a jump, stopping suddenly, and direct collision with another player, all of which are common aspects of these three sports.

WHAT ARE THE SYMPTOMS?

When the tear happens you may hear a popping noise and/or feel your knee give out from under you. Within 24 hours you’ll begin to feel severe pain and swelling in your knee and aching or tenderness in the joint.

WHAT IS THE TREATMENT?

A medical professional may be able to determine the severity of your injury with a physical exam; in some cases you need an X-ray or MRI to confirm the diagnosis.

Once diagnosed, patients will almost always have to receive surgery. For older athletes, or those who are relatively inactive, a brace and physical therapy may be enough to heal the injury.

In almost every other case, however, a minimally invasive surgery is required to reconstruct the ligament. Post-surgery recovery time varies from one athlete to the next, but most people are able to return to their sport within six to nine months, according to Health.UCSD.edu.

ACL injuries are very common, and almost always result in a complete tear of the ligament. Work to prevent this injury by keeping your lower body strong with jump squats, lunges and landing practice.

Unfortunately, even a strong lower body can’t prevent an ACL tear. Knowing the symptoms ensures you can seek medical attention immediately, and ultimately results in a quick return to your sport.

The reality is that there is no quick fix to an ACL injury, however there is a solution to ease pain and speed up recovery: wearing an ACL brace.

With the right brace, the ACL will have the support it’s needed to take pressure off of it while you are rehabbing it back to health. Bracing stabilizes the knee while in motion and helps protect the knee during everyday life and sport. It also keeps you confidence up, knowing that you can return to your activity, at the skill level pre-injury, with the right protection. And with the latest technology, braces today are not bulky, letting you focus on your sport without any heavy equipment or fuss.

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What Is Physical Therapy? How to Feel and Function Better

in ACL, Back Pain, Bone Health, Fractures, Hand & Wrist, Injuries, Knee, Neck Injuries, Shoulder, Sports Injuries
Original Article by WebMD Medical Reference

Your doctor might suggest this type of treatment if you’ve had an injury or illness that makes it hard to do daily tasks. Physical therapy (PT) is care that aims to ease pain and help you function, move, and live better. You may need it to:
  • Relieve pain
  • Improve movement or ability
  • Prevent or recover from a sports injury
  • Prevent disability or surgery
  • Rehab after a stroke, accident, injury, or surgery
  • Work on balance to prevent a slip or fall
  • Manage a chronic illness like diabetes, heart disease, or arthritis
  • Recover after you give birth
  • Control your bowels or bladder
  • Adapt to an artificial limb
  • Learn to use assistive devices like a walker or cane
  • Get a splint or brace

People of all ages get physical therapy. It can treat a variety of health problems.

What Is a Physical Therapist?

These licensed health professionals get specific graduate training in physical therapy. You may hear them called PTs or physiotherapists.

Some PTs get a master’s degree. Others also have a doctorate in physical therapy. They must pass a national exam to get certified. They’re licensed by the states where they practice.Physical therapists look at your needs and guide your therapy. They may perform hands-on treatments for your symptoms. They also teach you special exercises to help you move and function better.In most states, you can go directly to a physical therapist without a referral from your doctor. Or your doctor might prescribe it. Check your insurance policy to see if you need a prescription to cover the cost.If you have a serious illness or injury, a PT won’t take the place of your doctor. But he will work with your doctors and other health care professionals to guide treatments. You’ll feel better and you’ll be more likely to get back full function in the area being treated.PTs often have assistants. They’re also trained to do many types of physical treatments.

What Does a PT Do?

At your first therapy session, your PT will examine and assess your needs. He’ll ask you questions about your pain or other symptoms, your ability to move or do everyday tasks, how well you sleep, and your medical history.

The PT will give you tests to measure:
  • How well you can move around, reach, bend, or grasp
  • How well you walk or climb steps
  • Your heartbeat or rhythm while active
  • Your posture or balance

Then, they will work with you to create a treatment plan. It will include your personal goals like functioning and feeling better, plus exercises or other treatments to help you reach them.

You may take less or more time to reach those goals than other people in physical therapy. Everyone is different. You may also have more or fewer sessions than others. It just depends on your needs.

You treatments might include:

  • Exercises or stretches guided by your therapist
  • Massage, heat, or cold therapy, warm water therapy, or ultrasound to ease muscle pain or spasms
  • Rehab to help you learn to use an artificial limb
  • Practice with gadgets that help you move or stay balanced, like a cane or walker

Your therapist will watch your progress and adjust your treatments as necessary.

You can do the exercises your therapist teaches you at home between sessions. This will help you stay on track and improve your fitness.


New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

https://nmortho.com/wp-content/uploads/2018/09/physicaltherapy.gif 300 833 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2018-09-12 21:57:432018-09-12 21:57:43What Is Physical Therapy? How to Feel and Function Better
orthopedic doctors, in albuquerque, new mexico

ACL Surgery Often Successful Over Long Term

in ACL, Studies

Article Found on WebMD | By Mary Elizabeth Dallas

People who undergo knee surgery for a torn anterior cruciate ligament(ACL) can expect to stay active and maintain a high quality of life, researchers report.

Activity levels may decline over time, but a new study found that those who had the knee operation could usually still play sports 10 years later.

“An active patient may view an ACL injury as devastating, but our research adds to short- and long-term studies that show a good prognosis for return to pre-injury quality of life,” said the study’s corresponding author, Dr. Kurt Spindler. Read more

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orthopaedic surgeons, albuquerque, new mexico

Study Reveals the Body’s Systemic Stem Cell Response to ACL Injury

in ACL, Sports Injuries, Studies

Article Found on News-Medical.net

You might think stem cells only exist inside a fetus, but your adult body has a stockpile of stem cells, armed and ready to respond. These remarkable cells can develop into any other type of cell, like muscle or bone or nerve cells.

Researchers know heart attacks and strokes summon these cells. They flock to your heart or brain from all over your body to help you stay alive.

But, scientists did not realize other injuries, like a torn ACL of the knee, could command the army of stem cells to deploy. Read more

https://nmortho.com/wp-content/uploads/2017/06/orthopaedic_surgeons_albuquerque_new_mexico.jpg 300 832 nmortho https://nmortho.com/wp-content/uploads/2023/05/NMO-Logo-Teal.png nmortho2017-06-24 00:32:552017-06-24 00:32:55Study Reveals the Body’s Systemic Stem Cell Response to ACL Injury
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