When Is ACL Reconstruction Necessary?

High school, college, and professional athletes and their families, friends, and fans know the pain and long recovery associated with an anterior cruciate ligament (ACL) tear or rupture. Houston Texans fans know the story of running back Lamar Miller, who rushed for nearly 1,000 yards in 2018, earning a spot in the Pro Bowl. In the 2019 preseason, however, Miller tore his ACL and has since recorded just one rushing attempt. 

ACL reconstruction is known for long recovery times, and it can often take athletes over a year to return to the game after surgery. Despite this, not all ACL injuries are complete tears, and you may not need reconstruction surgery to fully heal and get back in the game. 

If you or someone you love has an ACL injury, see our team at Steven E. Nolan, MD. Dr. Nolan, our board-certified orthopedic surgeon with over 20 years of experience, has received numerous top-surgeon awards. 

Here, he discusses ACL injuries and when reconstructive surgery may be necessary.

ACL basics

At the hinge of your leg, right behind your knee cap, four ligaments facilitate movement and help you walk and run. The ACL is attached to the femur (thigh bone) on one end and the tibia (shin bone) on the other. It controls how far the tibia can slide from the femur and plays a major role in your knee's stability. 

How is the ACL typically injured?

ACL injuries occur when you make a sudden twisting movement or a quick, sharp turn while running or jumping. Because of this, athletes in sports with a lot of jumping or sudden cuts, like soccer, football, basketball, and volleyball, are more susceptible to ACL injuries. 

Women, who biomechanically put more stress on their knees, are more likely to suffer an injury than men. ACL injuries often occur with other injuries, such as a meniscus injury or MCL (medial collateral ligament) tear. 

When reconstruction is needed

There are three grades of ACL injuries:

• Grade 1: This type of injury is mild, and the ACL can still stabilize the knee
• Grade 2: The ACL is partially torn and stretched near its limits; knee stability is shaky 
• Grade 3: The ACL tears completely and/or the ligament pulls away from the bone; the knee joint is unstable

Grade 1 injuries can typically heal without surgical intervention. Joint immobilization, physical therapy, and a gradual return to regular activities give the injury time to heal, and over-the-counter pain medication can control any discomfort. 

Grade 2 ACL injuries are less common, as excessive force usually results in a complete tear. Treatment for such injuries depends on the specific situation. 

Grade 3 injuries require reconstruction to either re-attach the ACL to the bone or reconstruct the torn ligament. Dr. Nolan uses arthroscopy, a noninvasive surgical technique with a camera and thin instruments, to reconstruct ACL. The benefits of arthroscopy include: 

• Easily see and operate on the knee structures
• Use smaller incisions than open surgery
• Perform diagnostic arthroscopy at the same time
• Encounter fewer risks than with open surgery

Arthroscopy typically involves less trauma than traditional open surgery, which can decrease pain and recovery time. 

Dr. Nolan is an expert on ACL injuries and reconstruction surgeries — he can help you get back to the sports and exercise you love. Request an appointment online or over the phone with Steven E. Nolan, MD, today.