Originally published in the Williamson Herald —

With fall athletic seasons coming to an end, many athletes are starting to address injuries and make a recovery plan for the off season. While patience is required with any kind of injury, ACL injuries require special dedication and persistence to heal, especially if the athlete expects to return to play the following season. Sometimes, the severity of the tear requires the ACL to be surgically reconstructed before a recovery plan can truly begin.

Dr. Matt Anderson, orthopaedic surgeon at the Bone and Joint Institute of Tennessee, discusses improvements in ACL reconstruction surgery and the procedure’s critical role in the long road to recovery.

“The anterior cruciate ligament (ACL) is one of four major ligaments that stabilize the knee. The ACL crosses the inside of the knee, connecting the lateral (outside) femur to the medial (inside) tibia, providing both translational and rotatory stability. It is essential for cutting, pivoting and jumping activities and can be injured during both contact and non-contact sports,” said Dr. Anderson.

Contact and collision sport athletes are susceptible to ACL injuries due to high-risk activities such as tackling and slide-tacking. However, certain movements including cutting and pivoting, which are common to both contact and non-contact sports like tennis and pickleball, can also lead to ACL injuries. Additionally, whenever an athlete jumps and lands in a valgus position, with the knees angled in towards one another, the ACL is at increased risk of injury.

“When an athlete experiences a suspected ACL injury, it is important to do various assessments before making a decision about surgery,” said Dr. Anderson. “We start with a physical exam to assess the stability of the knee, and we obtain x-rays to rule out a fracture. Next, we perform an MRI scan to assess the severity of the ACL injury and to check for concomitant injuries to the menisci and/or other ligaments of the knee. Once we have all this information, we speak with the patient regarding his or her desired level of activity following recovery in order to determine the appropriate treatment.”

Dr. Anderson emphasizes that achieving knee stability is the primary goal of all ACL treatment plans. If the knee remains unstable, continued activity can lead to additional injuries of the menisci, cartilage, and other ligaments of the knee.

With stability in mind, reconstruction surgery may be the best solution for an optimal recovery. Recent advancements in this procedure have greatly improved patient outcomes.

“We have made changes in our surgical techniques to more accurately recreate the anatomic structure and orientation of the ACL within the knee,” said Dr. Anderson. “This reduces the possibility of a retear and allows the ligament to function more naturally.”

Dr. Anderson added that during an ACL reconstruction, the surgeon typically uses tissue from another part of the patient’s body to recreate the ligament. While orthopaedists have traditionally used the hamstring or patellar tendons, the quadriceps tendon has become increasingly popular over the past two decades.

“Additionally,” Dr. Anderson added, “we have seen a renewed interest in performing ACL repair as opposed to reconstruction. If the ACL tears near the top of the ligament and sufficient tissue remains, we can sometimes reattach the ligament with the addition of biological augmentation to enhance healing.”

Although the recovery time is similar to ACL reconstruction, repairing an ACL allows the patient to preserve their own ACL tissue. Additionally, the native ACL possesses proprioceptors or nerve endings that assist with movement and may lead to improved long-term outcomes.

“ACL surgery is often times viewed as the most important aspect of recovery from an ACL injury, but it is only a small part of a much longer journey,” said Dr. Anderson. “Setting up a patient for a successful recovery, both mentally and physically, starts prior to surgery.”

When patients visit the clinic with ACL injuries, Dr. Anderson assesses their range of motion and often recommends physical therapy in preparation for surgery. If a patient goes into surgery with a stiff knee, he or she will likely come out of surgery with a stiff knee. As such, it is important to correct range of motion deficits as much as possible before going to the operating room.

“We also make sure to walk through every step of recovery with the athlete before surgery and set concrete milestones with specific criteria, so they know what to expect,” said Dr. Anderson. “Physical therapy often begins as early as 1-2 days post-surgery, starting with range-of-motion exercises and progressing to strengthening. Agility drills are often initiated around the four-month mark.”

With an average total of nine months to be cleared for full activity, an injury of this severity can also take a severe psychological toll on the athlete.

“ACL patients can benefit from visiting a sports psychologist throughout their recovery journey,” said Dr. Anderson. “It is important to take care of yourself so that when you are physically healed you are also mentally prepared for return to competition.”

ACL injury prevention research continues to improve with new ways to identify and correct abnormal movements in sports. Sports medicine providers are continuing to learn about the functionality of muscles and joints through a series of studies involving body sensors that measure how mechanics change with fatigue.

Despite significant advances in ACL injury prevention, however, some ACL injuries are inevitable. Dr. Anderson and the experienced providers at Bone and Joint Institute are available assist the athletes should they suffer from an ACL injury.

“The key to a healthy recovery is communication,” said Dr. Anderson.  “It is crucial to have good alignment between the physician, physical therapists, athletic trainers and coaching staff to adjust the recovery protocol to fit each athlete’s specific needs.”

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