Mayo Clinic: Iím a 25-year-old woman, and I recently tore my
ACL playing basketball. My doctor says I donít need surgery
and recommends physical rehabilitation instead. Can rehab
completely fix the problem, so I can stay active? I love
playing basketball and skiing. I donít want to give them up,
but I donít want to wreck my knee either.
Surgery isnít always necessary to treat an anterior cruciate
ligament (ACL) tear. Physical rehabilitation can strengthen
the muscles around the joint and, in some cases, allow a
return to physical activity. But, thatís usually true only
if your activity does not involve aggressive cut and pivot
movements, or jumping and high impact. The activities you
mention, however, raise your risk for knee instability if you
choose not to have your ACL repaired surgically.
are strong bands of tissue that connect one bone to another.
Your ACL is one of two ligaments that cross in the middle of
the knee and connect your thighbone, or femur, to your
shinbone, or tibia. The ACL helps to keep your knee joint
ACL is torn, it usually causes knee pain and swelling. After
an ACL injury, you also may feel instability in the knee or
feel that the knee is "giving way" when you turn
quickly or pivot. Often, a "pop" is heard or felt.
ACL injuries frequently happen as a result of suddenly
stopping, changing directions or pivoting. Sports that put you
at risk of an ACL injury include basketball, singles tennis,
football, volleyball and soccer. Downhill skiing also puts you
at risk, because the length of a ski, combined with the
rigidity of ski boots, places considerable force on your knee.
purpose of treatment for an ACL injury is to reduce pain and
swelling, restore normal knee movement, strengthen the muscles
around the joint and allow a return to activity. For some
people, this can be achieved with physical rehabilitation
alone. If one of the menisci ó the cushioning cartilage in
the knee joint ó is also torn, however, that can increase
knee instability, making surgery the best option. It is
worthwhile to note, too, that an ACL tear raises your risk of
developing arthritis in your knee joint later in life. Studies
show that risk to be similar whether or not you have surgical
often involves working with a physical therapist to learn
exercises that strengthen your leg muscles, as well as the
muscles in your hips, pelvis and lower abdomen. Increasing
muscle strength helps stabilize your knee joint, making it
less susceptible to further injury.
your risk of another ACL tear, a physical therapist should
assess your movement patterns when you jump, land, pivot and
change directions. Often, this will include a video analysis
of how you land from a jump. Improving your movement patterns
with corrective exercises can go a long way toward protecting
against ACL injuries.
go back to your activities, having the proper gear also can
help lower your risk of injury. Wear appropriate footwear when
you play basketball. When you go downhill skiing, adjust your
bindings correctly, so your skis will release when you fall.
Some people wear a knee brace after an ACL injury, especially
if they have not had surgical reconstruction. Research has
shown, however, that wearing a brace does not appear to
prevent or reduce the risk of an ACL injury.
continue to have episodes of knee instability despite physical
rehabilitation or if you want to return to activities that
place your knee at higher risk for further injury, consider
ACL reconstruction surgery. Because a torn ACL can't be sewn
back together, surgery involves replacing the torn ligament
with a piece of tissue (i.e., a portion of your patellar or
hamstring tendons) called a graft.
your doctor and your physical therapist about your sports and
activity desires after your ACL injury. They can help you
create a treatment plan that fits your goals and gives you the
best odds for a safe return to activity.