Sidelined for Surgery: ACL Tears
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
If you're a sports fan, you probably know what an ACL is. It stands for anterior cruciate ligament and it is commonly injured among athletes. Patriots quarterback Tom Brady and golfer Tiger Woods have each suffered an ACL injury and both required surgery and missed their respective seasons.
The ACL is one of the four major ligaments that connect the bones in the knee joint. Typically, the ligament tears or ruptures during a pivoting movement or, in Brady's case, when hit. The injury usually requires surgery followed by a lengthy recuperation period.
"It is typically a sports-related injury," says Dr. Arun J. Ramappa, orthopedic surgeon and Chief of Sports Medicine at Beth Israel Deaconess Medical Center. "The injury is most common in basketball, football, soccer and skiing and occurs during a pivoting episode. Sometimes, it is due to contact when struck by an opposing player. It doesn't occur as frequently in non-pivoting sports such as running. You can also injure the ACL in a car accident or in a fall."
Sometimes, an ACL tear is accompanied by a tear in another of the four major knee ligaments, such as the MCL or medial collateral ligament, particularly when the injury is the result of a collision. That is what happened to Brady. In such cases, the MCL is allowed to heal on its own, and then the ACL is repaired surgically about four to six weeks later, Ramappa says.
The operation usually is done arthroscopically -- in a minimally invasive fashion using an arthroscope, a type of endoscope or tube that is inserted into the joint through a small incision. It means the joint does not have to be opened up fully, reducing recovery time.
The operation involves using a graft to replace the damaged ligament. The most common grafts are taken from the patient's own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. A graft may also come from a cadaver.
"It is usually done in an outpatient setting, under general anesthesia, and the patient goes home the same day," says Ramappa. "Typically, the operation is very successful. Patients usually return to their prior level of activity."
The patient usually undergoes physical therapy for several weeks and may be on crutches for a brief period. It is usually six to nine months before a patient is back to playing sports, Ramappa says.
Cedric Tonello of Boston was 33 when he injured his ACL while playing basketball a little over a year ago. "I was going to the basket," he says. "I made a move left, then tried to go right and my knee gave out."
Cedric underwent physical therapy prior to the operation to build up muscle on the leg where they were going to take a tendon from a hamstring. Dr. Ramappa operated on him about a month after the injury occurred.
"The surgery went extremely well," says Cedric, who is a regional business manager. "I was on crutches for about two weeks and wore a knee brace for two weeks after I went back to work."
Cedric says he began physical therapy three days after the operation and returned to playing basketball and tennis after about six months.
"Everything is fine now," he says. "I don't feel any pain. I'm very happy."
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted March 2011