ACL Tears: Recovery, Symptoms, and When to Consider Surgery

Q: ACL Tears: Recovery, Symptoms, and When to Consider Surgery

Hello： A rupture of the cruciate ligament primarily leads to knee instability during sudden stops, sharp turns, and changes in direction, as well as chronic long-term instability resulting in wear and tear of the knee joint cartilage and meniscus. <br>Conservative treatment, such

Anterior cruciate ligament tear

Two and a half months ago, I injured my knee while playing basketball, and an MRI showed a torn anterior cruciate ligament (ACL) and bone contusions.
Initially, for over a month, I couldn't fully extend my leg or bend it beyond 90 degrees.
Now, after some stretching and physical therapy, I can extend my leg to 0 degrees, but I still can't achieve negative angles.
My bending has improved significantly.
Walking has become smoother over the past two weeks.
However, I feel that my quadriceps on the inner thigh doesn't seem to generate power effectively, and I can't maintain consistent force.
When I practice certain movements compared to my good leg, I clearly can't exert full strength, and it feels like I'm not engaging that muscle properly.
Could this be related to my knee not being able to fully extend yet? Additionally, during some light squats, I occasionally feel pain on the inner side of my knee.
Should I stop training because of this? Lastly, I still experience a slight swelling sensation in my knee when walking, and sometimes I feel pain in the area of the ligament injury.
After walking for a while, my knee feels swollen.
Is this normal after more than two months? Does a torn ACL require a long recovery time? Given these issues, is surgery necessary? I’ve read online that many recommend conservative treatment first, but under what circumstances should one decide to proceed with surgery? Thank you for your answers.
🤝

Rickyku, 20~29 year old female. Ask Date: 2021/11/10

Dr. You Dianqi reply Orthopedics

Hello: A rupture of the cruciate ligament primarily leads to knee instability during sudden stops, sharp turns, and changes in direction, as well as chronic long-term instability resulting in wear and tear of the knee joint cartilage and meniscus.
Conservative treatment, such as strengthening exercises for the quadriceps, is certainly an option.
It is common to experience some discomfort during training, but it is important to monitor whether this discomfort is increasing or decreasing.
If it is the latter, further investigation is necessary.
If your chosen activities frequently involve sudden stops, sharp turns, and changes in direction, and if knee instability remains significant after quadriceps training, surgery may be a consideration you need to explore.
Thank you.

Reply Date: 2021/11/10

More Info

Understanding ACL tears and their management is crucial for anyone who has experienced such an injury, especially for athletes. Anterior cruciate ligament (ACL) tears are common in sports that involve sudden stops, jumps, or changes in direction. Given your situation, let’s break down your concerns regarding recovery, symptoms, and when to consider surgery.

Recovery from ACL Tears
Recovery from an ACL tear can vary significantly depending on the severity of the injury, the individual's overall health, and the treatment approach taken. In your case, it seems you have made some progress in your recovery. Initially, you experienced significant limitations in knee extension and flexion, which is common after an ACL injury. The fact that you can now achieve full extension (0 degrees) and are close to full flexion is a positive sign.

However, the feeling of weakness in your quadriceps, particularly on the inner side, is not unusual. After an ACL injury, it is common for the muscles around the knee to weaken due to disuse and pain. This muscle atrophy can lead to difficulties in performing certain movements and may contribute to your inability to exert full force compared to your uninjured leg.

Symptoms and Pain Management
The pain you experience during certain movements, such as deep squats, particularly on the inner side of the knee, could be attributed to several factors. It may be due to residual swelling, irritation of the joint, or even compensatory movement patterns that have developed as a result of your injury. The sensation of swelling or "puffiness" in the knee after prolonged activity is also common and can be a sign of inflammation or fluid accumulation in the joint.

When to Consider Surgery
Regarding the decision to undergo surgery, it is essential to consider several factors:
1. Severity of the Tear: Complete tears often require surgical intervention, especially for athletes who wish to return to high-level sports. Partial tears may be managed conservatively, depending on the individual's activity level and goals.

2. Functional Limitations: If you find that your knee instability or pain significantly limits your daily activities or sports participation, surgery may be warranted.
3. Response to Conservative Treatment: If you have been undergoing physical therapy and are not seeing improvements in strength, stability, or pain levels after several months, it may be time to reevaluate your treatment plan with your orthopedic surgeon.

4. Presence of Other Injuries: If there are additional injuries, such as meniscal tears or damage to other ligaments, surgery may be necessary to address these issues comprehensively.

Conclusion
In summary, while your recovery is progressing, the ongoing symptoms you describe—weakness in the quadriceps, pain during certain movements, and a sensation of swelling—are not uncommon after an ACL injury. It is crucial to continue with your physical therapy, focusing on strengthening the quadriceps and improving overall knee stability. If your symptoms persist or worsen, or if you feel that your knee is unstable, it would be wise to consult with an orthopedic specialist to discuss the possibility of surgical intervention.

Ultimately, the decision to proceed with surgery should be made collaboratively with your healthcare provider, taking into account your specific circumstances, goals, and the results of any further evaluations.

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