The Anterior Cruciate Ligament, or ACL, is considered by many to be the most important ligament contributing to the stability of the knee. Attached from the front portion of the tibia to the back of the femur, the purpose of the ACL is to prevent the knee joint from shifting out of place or rotating over the femur. Because of its location and purpose the ACL is very susceptible to injury especially in an athletic environment that requires the athlete to change direction, or cut, quickly. In fact an estimated 70% of all ACL tears happen under these exact circumstances.
Once an individual has injured their ACL treatment is necessary. Depending on the severity of the tear many patients opt to undergo surgery in an effort to bring stability back to the knee joint as they strive to return to their previous level of activity as soon as possible. However, a growing portion of patients are choosing to rehabilitate their injury without any surgical intervention. In this article we will explore alternative treatment options as we discuss which patients are most likely to benefit form this type of therapy.
The goal of non-surgical ACL therapy is the same as any other treatment option, to restore the patient to a condition equal or close to their pre-injury state. This type of treatment approach also goes hand in hand with patient education. The idea being to show the patient how to prevent instability as they rehabilitate their injury and return to their normal level of activity.
It is important to note that not all patients will qualify for a non-surgical ACL treatment protocol. If a patient is facing combined injuries of the knee then surgical treatment will likely be their only option. However, studies show that non-surgical methods may be effective or even indicated in patients:
· Who suffered a complete tear yet exhibit no instability of the knee joint during low-impact activity.
· Who live a more sedentary lifestyle and only perform light manual labor.
· With no instability and only a partial tear.
· Who are still developing and growing.
If a patient meets one or more of these requirements then they are likely an ideal candidate to move forward with non-surgical treatment options.
The basis of non-surgical treatment of an ACL tear is to improve stability. As such, these treatments may be prescribed in conjunction with the use of a hinged knee brace. The therapy begins with a patient’s initial visit to their healthcare professional. After assessing the severity of the injury the patient should be sent home to rest as they begin anti-inflammatory therapy and drastically modify their daily activity. The goal of this first stage is to reduce swelling so the patient is able to regain a normal range of motion through their knee joint. Typically patients will also report an improvement in joint strength during this phase.
Once the swelling has subsided the patient will begin their non-surgical rehabilitation. This includes targeted treatment with a physical therapist who will work towards improving the patient’s range of motion and strength. The patient will work on exercises like belt stretches, heel slides and quad stretches as they slowly warm their body and enhance their range of motion. Next they will work on strength through a variety of exercises such as heel raises, lunges, hamstring curls and squats.
Keep in mind that strength is key to a patient’s rehabilitation, especially directly after their injury. When a patient injures or tears their ACL they often find they lose control of their leg. Not only does the joint become unstable, but the muscles of the thigh often become extremely weak. So if the patient steps wrong or their weight moves off center then their knee will collapse as the joint gives out completely. The only way to combat this factor of an ACL tear is to increase strength.
Along with physical therapy the patient will need to be mindful of their injury regardless of the setting. At home and work they will need to rest as much as possible and only increase their activity as instructed by their physical therapist. As part of this process the therapist may require that they use crutches for one to two weeks while the swelling subsides and pain recedes. The goal is to rehabilitate the patient without aggravating the knee, or worse, re-injuring the joint.
If a patient meets the requirements for non-surgical ACL rehabilitation and is dedicated to their treatment then they may be able to return to their normal activities within eight to ten weeks of their injury. However, recovery is different for every individual. What works perfectly on one case may prove completely ineffective with someone else. The recovery process is unique to the individual patient and will vary. If a patient has been diligent with their non-surgical rehabilitation efforts and still suffers from instability of the knee joint then they may want to explore surgical treatment options.
This type of non-surgical treatment can strengthen the leg and improve flexibility of the joint. It cannot repair the ACL. Because of this it will not be ideal for every patient. The only way to determine the appropriate treatment plan is to assess the individual patient and measure their desired daily level of activity. At that point it is possible to recommend treatment options and move forward.