ACL Resource Guide
It’s Friday night. Game night! All of your hard work and dedication has led to this moment. The early morning practices, long drives to work outs, preparing meals and making sure your schedule is flawless… Yes, I’m talking to all the athlete parents out there who work hard to provide their child the best opportunity to make it as far as they can go in the sport(s) of their choosing. You watch your children warming up for the game ahead, having fun with their friends, going through their pre game rituals. You have done everything you can to prepare your child for this moment, followed all the steps, taken them to all the private coaching lessons, worked with trainers to be sure your child is ready to dominate, or at the very least, not getting injured while playing. With warm ups complete, coaches and refs shake hands, it’s showtime. But unfortunately, to quote the great Yogi Berra, tonight got late early.
The moment will play in your head over and over again, searching for clues or maybe something you overlooked. You’re watching from the stands as your son or daughter’s team executes plays that have been practiced countless times, then suddenly the play is called dead and someone is lying on the ground away from all of the action. You see coaches and trainers trot over to the downed player, and the whole time you’re holding your breath hoping it’s not your child. As the player rolls over and you see the jersey number your nightmare comes true. They help your child off to the sideline to resume play, you go down to meet them, and so it begins.
You hear stories of people tearing their ACLs; surgery, rehab, potentially missing out on a whole year of sports. Things like scholarships? and, career ending injury? Pop into everyone’s head. However you never think that it could actually happen to your kin. We’re here to tell you that with the proper care, your child will be back playing sports quicker then you may think. With some hard work and a little know-how, this will just be a bump in the road on the long journey that is your child’s sporting career.
Now, back to that dreadful night.. Following the injury, your child may express they felt a painful pop in their knee, it will probably be accompanied by rapid swelling, and they may even describe the sensation of looseness or that their knee may buckle when putting weight on it. These are all common sensations and experiences following an ACL tear. So what is your ACL? What happens when you tear it? and where do you go from there?
First, If you suspect your child has torn their ACL, get them off their knee and utilize the R.I.C.E. protocall: Rest, Ice, Compression and elevation. Get their leg propped up above their heart and wrap their leg with some ice to help with the acute pain and swelling. Next, you need to figure out the severity of the injury since moderate sprains and full blown tears have similar symptoms. This means, getting into contact with an orthopedic doctor who has experience with ACL tears to get an MRI of your child’s knee in order to assess the damage accurately. Often, you may be able to walk with a torn ACL after injuring it. If a minor tear is suspected, you may be tempted to “wait and see” if it gets better. We would highly recommend against this as smaller tears can grow in size and without a properly functioning ACL the other structures of the knee will experience greater strain.
The ACL or the Anterior Cruciate Ligament is one of 4 main ligaments in the knee and it helps to maintain the static stability of the knee (the things that hold your knee together that aren’t muscles). It’s main job is to prevent the tibia ( the lower leg bone) from slipping forward on the femur (your upper leg bone). When it is torn the knee swells and the severity of pain varies depending on the grade of tear and the amount of associated injury sustained. For the simplicity of this article we will only be covering ACL tears alone, but FYI ACL tears often come with associated injuries with the MCL (Medial cruciate ligament) and medial meniscus, which are other static stabilizers in the knee. So dont be surprised if other structures of the knee are effected after tearing your ACL.
Once you’ve gotten your MRI, and the results of your MRI come back positive, the question becomes: Do you need surgery? In short, if your child plays sports and would like to continue playing sports, surgery is recommended in order to regain peak performance. Without repairing the ACL, side to side movements or rotational activities would become fairly difficult for your child athlete potentially leading to more significant trauma to their knee.
When picking a surgeon for your child, experience operating on pediatric ACLs trumps all else. I wouldn’t want an orthopedic surgeon that mostly performs knee replacements for the elderly repairing my childs ACL. To further vet your potential surgeon, utilizing healthgrades.com to look up ratings of specific surgeons can help you make your decision, or at least dwindle down your options.
The surgery includes: Confirming the ACL is in fact torn, harvesting and preparing the ACL graft (more on this to come), creating tunnels in the tibia and femur for the new ACL to connect, securing the newly harvested ACL in the appropriate spots in the knee and finally stitching the knee back up.
On the topic of grafts. There are two main options. Allografts and autografts. An allograft is taking a tissue from a donor and using it as your child’s ACL. An autograft is taking tissue from your child’s own body and using it as their ACL. Most commonly, the patella tendon or the hamstring tendon is used to create your child’s new ACL. Each comes with their pros and cons, but it’s important to know when you are discussing your child’s surgery with their surgeon so you can weigh the risks and benefits.
You’ve settled on a surgeon, you make the appointment, you go to see the doc, and the surgery is scheduled for…three weeks from now. It is best practice that the ACL reconstruction surgery is not performed immediately after injury, this is to prevent something known as arthrofibrosis, which is the excessive production of collagen and adhesions that result in restricted joint motion and pain. More important than time alone, objective criteria for performing the ACLr include reduction in perioperative swelling, edema, hyperthermia, and improvements in range of motion are all important indicators of when surgery should be performed.
So what do you do in the meantime? Preparing for your surgery with a physical therapist has been shown to improve overall outcomes after ACL reconstructions. We highly recommended Pre-Hab with an experienced physical therapist while waiting for your surgery date. Here are a few key goals to focus on in order to prepare you for your surgery.
- Control pain and swelling with the RICE protocol (Rest, Ice, Compression, Elevation)
- Improve and maintain knee range of motion.
- Heel slides – Lie on your back and slowly bend your knee and slide your heel up towards your buttocks.
- Stationary bicycle – Not for cardio but for knee bending and straightening
- Keep up leg strength including hip, quad, hamstring and calf strength. (Exercises should be performed in a pain free motion; stop any exercises that cause increased pain in your knee.)
- Straight leg raise (quads) – Laying on your back, bend your unaffected leg, make a quad muscle with your injured leg and raise your straight leg to the height of your bent knee.
- Standing knee flexion (hamstrings) – While standing, bend and straighten your injured knee.
- Bridging (hips) – Laying on your back, bend both your knees,using your gluts, lift your hips until even with your torso and upper legs.
- Heel raises (calf) – While standing, raise heels up and down off ground to engage your calf muscles.
- Maximize balance
- Single leg standing – Standing on one leg, balance for 30-60 seconds.
- Full body training – Continue to train the upper body and the uninjured leg!
- Maintain good mental health
- Have child attend practices and games to remain part of the team, keep spirits up in this down time.
- Dynamic activities, lateral movements and pivoting on your affected leg should be avoided or performed cautiously in order to mitigate risk of further knee damage when waiting for your ACL repair.
Most ACL reconstructions are done under general anesthesia. So you’ll be asleep during the surgery and not feel anything. The surgery usually takes 2 to 2½ hours, and your child won’t need to stay in the hospital overnight.
Now that your child’s surgery has come and gone, the real work begins. Physical therapy should start as soon as possible and is best to have a scheduled eval with an experienced physical therapist 1-2 days after your son or daughters surgery so you don’t risk waiting longer then you should. Like choosing your ortho surgeon, your ortho physical therapist should be experienced in ACL rehab. Some of your questions when meeting your physical therapist should include: how many clients have they worked with that have had a similar surgery to yours? How often do you treat those with ACL reconstructions? And overall experience practicing as a physical therapist.
While in physical therapy, similar to the prehab goals above, your child’s rehab goals will be to reduce pain and swelling, improve knee range of motion, and improve overall leg strength. However, in order to return to playing sports, further training is needed in order to return to their prior level of function and beyond! The rehab process will likely take 6-9 months before your child is ready to return back to their teams. In order to do this, they must go from walking with crutches to running, jumping, cutting and performing all of the necessary actions they need to perform when playing their sport. Thinking about this now will seem like that day may never come, but it will be here faster than you know it! This is why having an experienced physical therapist to help your child through this journey is absolutely crucial.
You can help your student athlete prepare for success by understanding some basics about sports injuries. As a parent, knowing how these sports injuries are addressed can make all the difference toward your child having a successful season or watching from the sideline. For more in depth information including Tip Sheets for Managing Sport Specific Injuries, go to www.PlayBetterWithPT.com