ACL Injuries: Symptoms, Diagnosis, and Treatment Options

Anterior cruciate ligament (ACL)

Hello, Doctor: I apologize for bothering you.
I was in a car accident on August 30 of this year, which resulted in a femur fracture.
At the time, I did not feel any pain in my knee.
After being discharged on September 6, I suddenly experienced severe knee pain one night.
For a while, I was unable to fully extend or bend my knee, and it was somewhat swollen and warm.
When I returned for a follow-up, an MRI was performed, and the doctor said it appeared to be a minor injury and should be fine.
However, now that it has been almost four months, I can extend and bend my knee, but it still swells, feels warm, and sometimes my leg feels weak.
I went to another hospital for an X-ray, and the doctor mentioned that my anterior cruciate ligament (ACL) might be torn, and the cartilage seems to be partially damaged, making it difficult to assess the situation.
They suggested that I may need to drill three holes to get a better look at the actual condition.
I would like to ask if surgery is definitely necessary in my case? Also, before the surgery, do I need to use crutches? Thank you, Doctor.
🙇🏻‍♀️

han, 20~29 year old female. Ask Date: 2021/12/27

Dr. Shi Guozheng reply Orthopedics

If a complete tear of the ligament is confirmed through arthroscopy and there is significant laxity in the knee joint, surgery may be necessary.
You can consult with a physician at a sports medicine center for further evaluation to determine if surgery is required.

Reply Date: 2021/12/27

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your knee injury following the car accident. It sounds like you have been through a challenging time, and I appreciate your patience as you navigate your recovery. Let’s break down your situation regarding ACL injuries, symptoms, diagnosis, and treatment options.

Understanding ACL Injuries
The anterior cruciate ligament (ACL) is one of the key ligaments that help stabilize the knee joint. ACL injuries are common, especially in sports and traumatic incidents like car accidents. Symptoms of an ACL injury can include:
1. Pain: This is often immediate and can be severe.

2. Swelling: This typically occurs within a few hours of the injury.

3. Instability: You may feel like your knee is giving way or unable to support your weight.

4. Limited Range of Motion: As you mentioned, difficulty in fully extending or bending your knee is common.

5. Heat and Tenderness: These are signs of inflammation in the joint.

Diagnosis
In your case, the MRI results indicated a mild injury, but the ongoing symptoms of swelling, heat, and instability suggest that there may be more significant damage, possibly to the ACL or the cartilage. The X-ray findings indicating a potential ACL tear and cartilage damage further complicate the picture.

Treatment Options
1. Conservative Management: Initially, many ACL injuries can be managed conservatively with rest, ice, compression, and elevation (RICE). Physical therapy can also help strengthen the muscles around the knee and improve stability. However, given your ongoing symptoms, this may not be sufficient.

2. Surgical Intervention: If the ACL is indeed torn and causing instability, surgical reconstruction may be necessary. The decision to proceed with surgery often depends on several factors:
- The severity of the injury.

- Your activity level and lifestyle.

- The presence of other injuries (like cartilage damage).

- Your overall health and ability to undergo surgery.

3. Preoperative Care: Before surgery, using crutches or a knee brace can help alleviate pressure on the knee and prevent further injury. It’s essential to follow your doctor’s advice regarding mobility aids. If you experience significant instability or pain, using crutches may be advisable to avoid putting weight on the injured leg.

Next Steps
Given that you have been experiencing persistent symptoms for nearly four months, it would be prudent to discuss the possibility of surgery with your orthopedic surgeon. They may recommend arthroscopy, a minimally invasive procedure that allows the surgeon to visualize the inside of the knee and assess the extent of the injury. This can help determine the best course of action, whether it be repair, reconstruction, or another treatment.

Conclusion
In summary, while some ACL injuries can heal with conservative treatment, your ongoing symptoms suggest that surgical intervention may be necessary. It’s crucial to have a thorough discussion with your orthopedic surgeon about your symptoms, the results of your imaging studies, and the best treatment options for your specific situation.
Please ensure you keep all follow-up appointments and communicate any changes in your symptoms. Wishing you a smooth recovery and the best of health.

Best regards,
Doctor Q&A Teams

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