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The anterior cruciate ligament, more commonly known as the ACL, is a critical ligament in the knee that provides stability for the joint. Spraining or tearing this ligament is one of the most common ways we injure our knees. When this type of injury occurs, everyday tasks become difficult to manage and even the simple act of walking may become too much to bear. Many of our orthopedic patients seek us out for a second opinion, wanting to know: “Do I need surgery for a torn ACL?”
We can’t answer this question without conducting a physical exam in our office and evaluating your injury in person, of course. But exciting new regenerative treatments are giving more patients the ability to get back to their normal, everyday activities without requiring ACL surgery. At CORE Medical & Wellness, we’re proud to be on the cutting edge of these new technologies with our Non-Surgical Orthopedics, Spine & Sports Medicine practice.
Here’s what you need to know about non-surgical treatment for torn ACLs.
What is a torn ACL?
You feel a pop in your knee while you’re going for a jog or playing tennis with a friend; the pain and swelling that follows let you know that something isn’t right. Yes, you’ve probably injured your ACL.
The ACL and another knee ligament, the PCL (posterior cruciate ligament), form an X on the interior of the knee joint. Their job is to prevent the knee from rotating too far and the femur from sliding backwards on the tibia. A sprained ACL occurs when the ligament is stretched or torn––a first-degree sprain is a stretched ACL, while a second-degree sprain is stretched and partially torn. The worst case scenario is a third-degree sprain, when the ligament is completely severed.
How do torn ACLs happen?
ACL injuries most often happen while a person is working out or participating in some kind of sport. They usually occur when you pivot unexpectedly with your knee locked. It is that action of taking a sudden turn on a knee that is locked firmly in place that results in a stretched or torn ligament. Other causes of torn ACLs include:
- Quickly changing direction
- Stopping suddenly
- Slowing down too fast while running
- Landing incorrectly after a jump
- Collision, as in contact sports
Interestingly, women are at higher risk for a torn ACL than men are. There is debate about why this is true; some experts suspect that it is because of differences in physical conditioning and muscle strength, while others believe estrogen affects the properties of ligaments.
What are the signs of a torn ACL?
The telltale popping sound mentioned above is usually the first sign of a torn ACL. This is followed by sharp, intense knee pain. The pain may be severe enough that you are not able to walk. Internal bleeding may cause a great deal of swelling, another reason that walking may be painful. This swelling can make it difficult, or even nearly impossible, to bend your knee.
How is a torn ACL diagnosed?
When you suspect you have a torn ACL, it is important to visit your doctor rather than simply self-diagnosing. Just because surgery may not be needed for torn ACLs doesn’t mean you don’t need any treatment at all!
During a physical exam at our office, we will look at your knee for swelling and bruising. Sometimes, it may be evident that the ACL is torn because the knee looks misshapen. We will examine the area for tenderness, swelling, and knee joint fluid and also assess your knee’s overall stability using a variety of tests and maneuvers. These tests may be uncomfortable, but they are important for us to determine the best course of treatment for your injury.
When needed, we may also do magnetic resonance imaging (MRI) to discern the degree of your ACL injury. Some patients wonder why we can’t use x-rays instead. X-rays can rule out broken bones, but do not tell us anything about your ligaments, so they are not usually used unless we have reason to suspect that a bone fracture may be presenting as an ACL injury.
Are there alternatives to surgery for a torn ACL?
In the past, the two primary approaches to dealing with torn ACLs were surgery and taking a wait-and-see approach. CORE Medical & Wellness offers innovative regenerative medicine options for treating ACL injuries.
It should be noted that the wait-and-see approach doesn’t mean doing nothing; instead, it means pursuing conservative treatment options like physical therapy and knee braces rather than going straight to surgical intervention. Research has shown that rehabilitation is an effective way to reduce the need for surgical reconstruction in ACL patients.
According to the American Academy of Orthopaedic Surgeons, non-surgical management of ACL injuries is most likely to be successful in patients who:
- have partial tears and no instability symptoms
- have complete tears and no symptoms of knee instability during low-demand sports
- are willing to give up high-demand sports
- do light manual work or live sedentary lifestyles
- are children with open growth plates
Regenerative medicine works best in conjunction with other non-surgical treatments for torn ACLs. It supports the work you do in physical therapy, helping your injured ligament heal without surgical intervention.
What are the regenerative medicine options for a torn ACL?
The modalities we offer at CORE Medical & Wellness are Platelet-Rich Plasma (PRP) and Bone Marrow Concentrate (BMC) therapies. These utilize your own blood to heal your injury and they are increasing in popularity in the world of sports medicine.
Once we’ve extracted your blood, we will place the sample in a centrifuge to separate the serum into white blood cells, red blood cells, plasma, and platelets. The stem cells or platelet-rich plasma is then injected into your knee, with the guidance of a Doppler ultrasound, to promote healing and ligament repair. The procedure takes about 30 minutes, start to finish, and involves only a small amount of discomfort from the blood draw and subsequent injection.
Depending on the severity of your injury, you may only need two injections or you may need to come back for six visits. Patients usually see pain start to subside after the first or second injection.
Because PRP is made with your own blood, it is a safe treatment option with very low risk of adverse reactions.
Another benefit of pursuing treatment for your torn ACL at CORE Medical & Wellness is that we are an integrated health practice. Our orthopedic and regenerative medicine physicians can treat the injury to your ACL and our NJ pain management specialists can alleviate your discomfort. Our team works together to treat all aspects of your health for the best possible results. We treat the whole patient, not just the injury or disease.
What are the risks of ACL surgery?
The same risks that are present for all surgeries are also present for ACL surgery. These include complications from anesthesia, blood clots, and infection. Complications specific to ACL surgery include persistent joint stiffness and pain, re-rupture of the ligament graft, and the possibility that surgery will not effectively treat the injury.
What are the risks involved in delaying surgery?
The reason why doctors have traditionally steered patients towards ACL surgery as opposed to other treatment options is because they want to avoid any worsening of the tear. Irreversible knee damage is a risk of delaying surgery, to be sure, but this risk can be mitigated with proper care from a qualified physician. It’s also important for patients to comply with the instructions they are given and not return to strenuous physical activities before their injury has resolved.
Another reason why some patients pursue surgery is because they want to get back to their normal activities faster. This is understandable, but remember that surgery itself also requires time for rest and recovery afterwards.
What is the bottom line on treatment for torn ACLs?
Surgery is generally recommended for people with recurring ACL injuries and high level athletes who plan on returning to their sport of choice. The AAOS recommends non-surgical treatment for patients who have a lower activity level or more minor ACL injuries.
With recent innovations in regenerative medicine, we think even athletes and patients with recurring injuries may want to put a pause on their plans for surgery and take some time to investigate non-surgical treatment for ACL tear injuries first.
Learn More About Non-Surgical Orthopedics, Spine & Sports Medicine
If you’re wondering if you need surgery for your torn ACL, we’d be happy to meet with you and discuss your treatment options in person. Schedule an appointment today to learn more about our cutting edge regenerative medicine therapies and non-surgical orthopedics.
Dr. Jag Desai, M.D. is double board certified in anesthesiology and interventional pain medicine. He specializes in preventing and treating degenerative processes that can lead to conditions such as: back pain, musculoskeletal pain, cancer pain, neuropathic pain, complex regional pain syndrome (CRPS), minimally invasive spine procedures, and muscle spasticity. Read his full bio here.