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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I've been told both by my orthopedic surgeon and the physical therapist that I can rehab my torn ACL without surgery. Does this hold up over time? Will I have to rehab it for the rest of my life?

Injury to the anterior cruciate ligament (ACL) of the knee has become a fairly common problem. Research indicates that with more people involved in high-level sports the chances that this trend will continue are pretty good. What does that have to do with you? Well, more people with ACL injuries means more data from studies to help us guide patients. We have more information now than ever before about what treatment works, who it works best for, and what techniques give the best results. For years now, partial tears of the ACL have been treated with a rehab protocol that doesn't involve surgery. This choice seems to work best for individuals who are not top athletes but rather, active but not overly active adults. Partial tears that do not respond to therapy and/or full ruptures may require surgery. A repair procedure for the tear or reconstruction for the full rupture may be advised. In a repair procedure, the surgeon stitches together the torn ends of the ligament. The ligament is still attached at both ends inside the knee joint offering some stability but at risk for reinjury or full rupture. In a reconstructive procedure for full rupture, one side of the ligament has either pulled away completely from the joint or a tear has occurred somewhere along the length of the ligament. A rupture is so severe, it has gone all the way through (ripping the ligament into two pieces). A piece of tendon from some other part of the knee is used to replace the torn ligament. The graft material may come from the patellar tendon (just under the knee cap) or the hamstring muscle (behind the knee). There is concern about further injury or reinjury for patients who don't fully recover with a rehab program. The damaged or deficient ligament doesn't recover with rehab. Instead, the muscles around the joint are strengthened to help stabilize the joint. The problem is that muscles doing the job of ligaments means they don't always do their own job of moving the joint properly. Without a stable, efficient joint and normal joint and muscle movement, the knee cartilage can get worn down faster. In the highly active individual, degenerative arthritis can develop over time. How well the knee holds up over time is an area of interest but more studies are needed to help us see the natural history (what happens over time) of the ligament and knee as a whole. Whenever there is a ligamentous laxity from injury, a strengthening program is a good idea -- even for the rest of your life. It will be insurance against reinjury of the already damaged ligament as well as prevention of injury of the surrounding soft tissue structures.


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