ACL Tear Treatment

What Is an ACL Tear?

The ACL, or anterior cruciate ligament, is a ligament in the knee that joins the thigh bone (femur) to the shin bone (tibia). Its main function is to prevent the shin bone from moving forward excessively below the thigh bone. The ACL also acts as the main stabiliser in the knee.

When the ACL is injured, it is called an ACL tear injury. Research shows that almost half of the knee injuries are because of ACL tears. These tears may be quite painful and can get aggravated if not properly evaluated and treated by a doctor. Read more about the causes and types of ACL tears and diagnosis.

ACL Tear Treatment in Singapore

An ACL tear can be a painful condition that may cause instability in the knees and difficulty in doing daily activities. The treatment for an ACL tear will depend on several factors such as the patient’s symptoms, age, lifestyle, kind of tear, and other related factors. Depending on each individual case, your knee specialist will determine whether it is to be treated through conservative options or through surgical intervention.

ACL Tear Treatment Without Surgery

Non-surgical treatment options for an ACL tear in Singapore are chosen for patients who have a minor tear, are older, or who lead a less active lifestyle. These conservative treatment options can include:

Medication

• Non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen for a few days.
• Help in reducing swelling associated with the injury.

Joint Aspiration

• The orthopaedic specialist may remove some fluid from the knee to relieve pressure from the area
• This can improve the range of motion, and reduce pain and swelling.
• This procedure is done under local anaesthesia where the doctor inserts a needle into the knee joint and removes the fluid.

Lifestyle Modification

• Avoid activities that put additional strain on the knees.
• Give the knee enough rest to heal.
• Applying ice to the affected area several times a day can also help with the pain and swelling.

Injections

Injections, on their own, are not considered a treatment option for a torn ACL. However, they may be used for symptomatic relief or as part of a combined treatment approach. The types of injections that may be used in case of ACL tear injury include:

• Corticosteroid Injections: Steroid injections are primarily used to reduce inflammation and pain in the knee with the tear.
• Platelet-Rich Plasma (PRP) Injections: Platelet-rich plasma (PRP) injections involve taking platelets from the blood of the same patient and injecting this plasma into the injury site to promote healing.
• Stem Cell Injections: Stem cell injections involve injecting the injured site with stem cells obtained either from the same patient or from some other donor. These injections facilitate the regenerating process and may help in regenerating the torn ligament in the knee.

Physical and Occupational Therapy

• Physical therapy is also an important modality in the treatment of ACL tears.
• The first goal of physiotherapy for ACL tear is to reduce swelling and inflammation by doing specific exercises and therapies, such as heat therapy.
• Once the swelling has subsided, the therapist will focus on strengthening the knee muscles by doing specific exercises and stretches.

Bracing

A specialised knee brace can help support your knee after an ACL injury and go a long way in facilitating recovery. Such a brace can also help prevent future injuries.

Surgical ACL Tear Treatment Options

Your Singapore orthopaedic surgeon may recommend surgical intervention for your anterior cruciate ligament tear especially if you are a sportsman or a person who wishes to return to a high level of activity. A torn ACL is not usually repaired as that involves repairing it with sutures. However, this procedure has been shown to fail over time. Therefore, surgical treatment for a torn ACL involves reconstructing the ACL.

ACL Reconstruction Surgery

The ACL reconstruction surgery involves replacing the torn ligament with a graft. The surgery is carried out arthroscopically in which the surgeon makes very small incisions on the knee. An arthroscope, which is a narrow tube that has a fibre-optic video camera attached to its end, is inserted through one of the incisions. The camera guides the surgeon to carry out the procedure in a much less invasive manner. The surgeon inserts thin surgical instruments through the other incisions to reconstruct the ligament. The process comprises the following steps:

• First of all, the surgeon cleans the knee joint area and removes the torn ACL.
• After that, the surgeon prepares the graft according to the size of the torn ligament where it is to be placed.
• To attach the graft to the thigh bone and shin bone, small holes are drilled into the bones.
• The graft is then threaded through the bone tunnels and fixed to the bones through screws and other fixation devices to hold the graft in place.
• Finally, the incisions are closed through sutures and the knee is bandaged.

ACL reconstruction surgery through arthroscopy is a minimally invasive procedure that results in lesser post-surgery pain and enables the patient to recover much faster as compared to an open knee surgery.

Revision ACL Surgery

When an initial ACL reconstruction fails or if the ACL is re-injured, it will call for a revision surgery.

• A revision ACL surgery is much more complex as compared to a first-time reconstruction surgery.
• There could be scar tissue in the knee area from the previous surgery, the bone structure might have changed, and the previous graft would need to be removed before replacing it with a new one.
• Such a revision surgery may need to be carried out as an open knee procedure instead of arthroscopy.
• The kind of graft the surgeon chooses for the revision surgery may differ from the previous graft choice.

Graft Sources For ACL Surgery

The graft that the surgeon chooses for an ACL reconstruction or revision surgery can be obtained from different sources discussed below:

Patellar Tendon Autograft

A patellar tendon autograft is a graft taken from the same patient’s patellar tendon, which connects the kneecap to the shin bone.

Hamstring Tendon Autograft

Hamstring tendon autograft is obtained from the semitendinosus hamstring tendon on the posterior and medial length of the thigh and inner side of the knee.

Quadriceps Tendon Autograft

Quadriceps tendon autograft is usually used for ACL reconstruction in patients who are taller and heavier. The graft is obtained from the middle-third part of the patient’s quadriceps tendon and a bone plug from the top of the kneecap.

Allografts

The grafts that are taken from other human donors instead of from the patient himself are called allografts. Allografts are mostly used for patients who have had a failed ACL reconstruction or who require repair and reconstruction in more than one knee ligament.