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Treatments and drugs

By Mayo Clinic staff

Initial treatment for an ACL injury aims to reduce pain and swelling in your knee, regain normal joint movement and strengthen the muscles around your knee. You and your doctor will then decide if you need surgery plus rehabilitation or intense rehabilitation alone.

Which option is right for you depends on several factors, including the extent of damage to your knee and your willingness to modify your activities. When a young child whose bones are still growing injures his or her ACL, doctors may recommend postponing surgery until the child's bones have stopped growing.

Short term
To treat the acute injury:

  • Use ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
  • Elevate your knee.
  • Take pain relievers such as ibuprofen (Advil, Motrin, others) as needed.
  • Wrap an elastic bandage around your knee.
  • Use a splint or walk with crutches if needed.
  • Work with a physical therapist on range-of-motion and muscle-strengthening exercises.

Surgery
A torn ACL can't be sewn back together. The ligament is reconstructed by taking a piece of tendon from another part of your leg and connecting it to the thighbone and shinbone (autograft). If your own tendons don't provide the best replacement for the injured ligament, your doctor may recommend using a tendon from a cadaver (allograft). The cadavers used for allografts have been carefully screened and tested for diseases.

You may consider surgery if:

  • Your knee is unstable and gives way during daily activities or sports
  • You're very active and want to resume heavy work, sports or other recreational activities
  • Other parts of your knee, such as the meniscus or other ligaments, were also injured
  • You want to prevent further injury to your knee

ACL reconstruction surgery is an outpatient procedure using arthroscopic techniques. The surgeon inserts a thin instrument (arthroscope) with a light and a small camera into one or two small incisions. This allows your surgeon to see the inside of your knee joint and make the repairs.

After surgery you'll go through a rehabilitation program. In addition to working with a physical therapist, you may wear a knee brace and you'll need to avoid activities that put undue stress on your knee. Most people can return to their sports about six months after surgery. About nine in 10 people who undergo ACL reconstruction report good to excellent results and satisfactory knee stability, according to the American Academy of Orthopaedic Surgeons.

Nonsurgical rehabilitation
A rehabilitation program without surgery involves physical therapy, modifying your activities and knee bracing. This approach can be effective as long as you're willing to give up the sports and other activities that place extra stress on your knee. You may want to consider rehabilitation alone if:

  • You have a partial tear
  • You don't participate in sports that involve cutting, pivoting or jumping
  • Your knee isn't painful or unstable during normal activities
  • You lead a fairly sedentary life
  • Your knee cartilage hasn't been damaged
  • You have advanced knee arthritis
Prevention Tests and diagnosis
References
  1. Friedberg RP. Anterior cruciate ligament injury. http://www.uptodate.com/home/index.html. Accessed Nov. 25, 2008.
  2. ACL injury: Does it require surgery? American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00297. Accessed Dec. 18, 2008.
  3. Friedberg RP. Patient information: Anterior cruciate ligament injury. http://www.uptodate.com/home/index.html. Accessed Nov. 25, 2008.
  4. Hergenroeder AC. Treatment of knee injuries in the young athlete. http://www.uptodate.com/home/index.html. Accessed Nov. 25, 2008.
  5. Spindler KP, et al. Anterior cruciate ligament tear. New England Journal of Medicine. 2008;359:2135
  6. Murray MM. Current status and potential of primary ACL repair. Clinics in Sports Medicine. 2009;28:51

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Jan. 3, 2009

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