The Anterior Cruciate Ligament (ACL) is one of the main ligaments(tough bands of connective tissue) that stabilizes the knee. It attaches your thigh bone (femur) to your shinbone (tibia) and prevents over-rotation.

We’ve all heard of the dreaded ACL tear, some of us (myself included) have even experienced them ourselves.  From Mariano Rivera in baseball to Derrick Rose in the NBA, ACL tears are everywhere. The fact is, each year over 200,000 ACL ruptures occur in the United States alone. 

But why are these tears so common?

The answer lies in the over-rotation protection function that makes the ACL so integral to athletic performance.  ACL tears usually happen when an athlete cuts, stops suddenly, or lands awkwardly. As the ACL attempts to prevent the knee from over-rotating in these situations, excess rotational stress means something has to give.

The ACL tear, on 70% of occasions, presents with an audible pop, which also makes the injury mentally tough. These days, due to the increasing frequency of athletic competitions, increasing athlete size and strength, and more active seniors the number of ACL tears seen around the world continues to rise. Although there is no evidence that conclusively proves ACL tears are more common now than 10, 100 or even 1,000 years ago. 

The ACL has probably always been the most likely ligament in the body to experience tears and unfortunately, it can’t always be repaired.

ACL Repair and Recovery

Orthopedic physicians around the world spend millions of hours annually fixing anterior cruciate ligament tears. After injury, ACL tears are usually diagnosed using the Lachman Test, then confirmed via an MRI. Although sometimes Doctors are forced to wait for swelling to subside before making a diagnosis.

Repairing the ACL is where things become a little tricky. There are multiple ways to fix the ACL. The first is called the ACL repair, the second ACL reconstruction.

ACL Repair

The ACL repair has fallen out of favor of late in the medical community, although it was once the first option for physicians. An ACL repair involves re-attaching the torn ACL to the bone with staples.

Many studies have concluded that patient outcomes overall are worse with this option. However, recent research from Gabriella Bucci MD at the Hospital Universitario General de Catalunya, Barcelona, in Catalunya, Spain revealed the repair procedure may be the way to go in certain situations where ACL tears are confined to the proximal region of the knee. 

ACL Reconstruction

ACL reconstruction has become the gold standard for the treatment of ACL injury in recent years because of superior overall patient results. 

The procedure involves the complete removal of the torn ligament followed by the placement of a replacement piece of tendon from the patellar tendon in your knee or from a deceased donor. 

Still, despite current treatment success, secondary knee osteoarthritis has been reported in over 70% of ACL reconstruction patients during their 10-year follow up.

The ACL is a tricky ligament and unfortunately, it can’t always be repaired. Seniors who already have arthritis usually aren’t valid candidates for surgery. That means the elderly are forced to live with pain and limited mobility as their only option for treatment is physical therapy.

Preventing ACL Tears

ACL tears are nasty injuries, so nasty they even discriminate, women athletes are four to eight times more likely to suffer from the injury than men. That means prevention is key.

Although preventing ACL tears has yet to become a proven science there are a number of recommendations for Doctors and physical therapists that one can follow.

First, performing exercises that strengthen and improve the flexibility of the leg muscles will help improve balance and reduce injury risk. Many physicians, in particular, recommend strengthening the hamstrings to help prevent muscular imbalances which can put extra strain on the knee.

However, perhaps the best thing you can do to prevent ACL tears is to improve your cutting technique. The vast majority of ACL injuries occur when poor technique puts strain on the knee during a sharp cut or quick stop. Improving technique can greatly reduce injury risk.

Finally, eating a healthy diet, and not pushing past muscle fatigue limits can help reduce your risk of an ACL tear significantly.

ACL tears can be scary, but there is a lot we can do to help prevent the injury. Awareness is always step one. Hopefully, this article will help you remain injury-free for years to come.