The anterior cruciate ligament is one of the main structures of the knee, connecting the femur (thigh bone) to the tibia (shin bone). A torn ACL is a common injury for athletes, whether a partial or complete tear.

Partial tears, depending on the severity, can be treated without surgery. Complete tears often require ACL surgery to reconstruct the ligament with tissue elsewhere in the body. ACL surgery at Princeton Orthopaedic Associates involves much more than the surgery itself. We have a staff of sports medicine physicians, orthopaedic surgeons, and physical therapists that will see you through your diagnosis, treatment, and recovery from start to finish. 

ACL Tear Diagnosis 

Patients with possible ACL tears will experience pain, swelling, and limited movement in the knee. You can heal a partial tear without surgery if proper treatment is carried out. Complete tears require surgery. 

Our Sports Medicine physicians at Princeton Orthopaedic Associates can determine whether you have a partial or complete tear through digital imaging and x-rays and two manual tests: 

Lachman Test: The physician tries to pull the tibia away from the femur. A partially torn ACL will still keep the bones from moving far apart, if at all. 

Pivot Shift Test: While the patient is on his back, the doctor lifts the leg and rotates it at the knee. If the bones shift, the ACL is likely torn. 

ACL Surgery: When and How

ACL surgery usually doesn’t happen right away. It’s best to let the inflammation and swelling subside first. Most surgeries are scheduled for 3-6 weeks after the injury. Performing the surgery too early can lead to complications such as arthrofibrosis, where excessive scar tissue grows in the area. However, we must do surgery within six months to achieve the best results. 

During surgery, the surgeon takes replacement tissue from the patient’s hamstring, quadriceps, or patellar tendon. In some cases, tissue from an organ donor is used, called an allograft. The type of tissue used is determined case by case. 

Most ACL surgeries are performed arthroscopically, which is minimally invasive and allows for faster healing and recovery. Small incisions are used for the insertion of a camera and small instruments. A larger incision is used to take the tissue graft. The graft includes a piece of bone on each end which serves as the anchor. Those pieces of bone are screwed into the tibia and femur to lock the new ACL into place, and they eventually fuse with the bones around them. Once the repair is made, the patient can usually go home the same day. 

ACL Surgery Recovery

Patients can begin walking with crutches and a leg brace soon after surgery, usually the same day. The patient starts a rehabilitation program to restore strength and stability within a few days. 

Athletes undergoing ACL reconstruction surgery usually have to wait 6-9 months to return to their sport. 

Patients will start with our physical therapists on range-of-motion and strengthening exercises. After about four months, patients will begin running exercises to improve mobility and endurance. Pivoting movements would start about five months for further range of motion. After that, the patient can start working out in their sport.

We can counter any pain after surgery and during treatment with a medication regimen. Recovery depends on the patient, the severity of the injury, and the willingness of the patient to stick to their physical therapy and rehabilitation routines.