ACL Video

About ACL Reconstruction

The sports medicine doctors at the University Orthopaedic Center have a long history of working with ACL injuries. The ACL (anterior cruciate ligament) is one of four ligaments that are crucial to knee stability. This strong fibrous tissue is part of a complicated network of tendons and ligaments that help stabilize and support the knee. This region is particularly vulnerable to injury during athletic activity or as the result of impact.

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ACL Protection & Prevention Program

Ligament Injuries to the Knee

What are knee ligaments?

There are 4 major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The 4 main ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include:

  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

  • Posterior cruciate ligament (PCL). The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone).

  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.

  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

How are cruciate ligaments injured?

The anterior cruciate ligament (ACL) is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

What are the symptoms of a cruciate ligament injury?

Often, a cruciate ligament injury does not cause pain. Instead, the person may hear a popping sound as the injury occurs, followed by the leg buckling when trying to stand on it, and swelling. However, each individual may experience symptoms differently.

The symptoms of a cruciate ligament injury may look like other conditions or medical problems. Always see your doctor for a diagnosis.

How are collateral ligaments injured?

The medial collateral ligament is injured more often than the lateral collateral ligament. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

What are the symptoms of a collateral ligament injury?

Similar to cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle, causing pain and swelling.

The symptoms of a collateral ligament injury may look like other conditions or medical problems. Always see your doctor for a diagnosis.

How is a knee ligament injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a knee ligament injury may include:

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film to rule out an injury to bone instead of, or in addition to, a ligament injury.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; can often determine damage or disease in bones and a surrounding ligament or muscle.

  • Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope) that is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative and/or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

Treatment for knee ligament injuries

Treatment may include:

  • Medicaine such as ibuprofen

  • Muscle-strengthening exercises

  • Protective knee brace (for use during exercise)

  • Ice pack application (to reduce swelling)

  • Surgery

Knee Ligament Repair

What is knee ligament repair?

Ligaments are bands of tough, elastic connective tissue that surround a joint to give support and limit the joint's movement.

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When ligaments are damaged, the knee joint may become unstable. Ligament damage often occurs from a sports injury. A torn ligament severely limits knee movement, resulting in the inability to pivot, turn, or twist the leg. Surgery is an option to repair a torn ligament if other medical treatment is not effective.

There are 4 major ligaments in the knee. The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:

  • Anterior cruciate ligament (ACL). The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).
  • Posterior cruciate ligament (PCL). The ligament, located in the center of the knee, that controls backward movement of the tibia (shin bone).
  • Medial collateral ligament (MCL). The ligament that gives stability to the inner knee.
  • Lateral collateral ligament (LCL). The ligament that gives stability to the outer knee.

Why might I need a knee ligament repair?

The anterior cruciate ligament (ACL) is located toward the front of the knee. It is the most common ligament to be injured. The ACL is often stretched and/or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

The posterior cruciate ligament (PCL) is located toward the back of the knee. It is also a common knee ligament to be injured. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

The medial collateral ligament (MCL) is located on the inner side of the knee. It is injured more often than the lateral collateral ligament (LCL), which is on the outer side of the knee. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the outer side of the knee, such as when playing hockey or football.

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Early medical treatment for knee ligament injury may include:

  • Rest
  • Ice pack application (to reduce swelling that occurs within hours of the injury)
  • Compression (from an elastic bandage or brace)
  • Elevation
  • Pain relievers

A knee ligament tear may be treated with the following:

  • Muscle-strengthening exercises
  • Protective knee brace (for use during exercise)
  • Activity limitations

Knee ligament repair is a treatment for a complete tear of a knee ligament that results in instability in the knee. Persons with a torn knee ligament may be unable to do normal activities that involve twisting or turning at the knee. The knee may buckle or “give-way.” If medical treatments are not satisfactory, ligament repair surgery may be an effective treatment.

The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft) or from an organ donor (allograft).

There may be other reasons for your healthcare provider to recommend a knee ligament repair.

What are the risks of knee ligament repair?

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bleeding
  • Infection
  • Blood clots in the legs or lungs

Some people may experience pain, limited range of motion in the knee joint, and occasional swelling in the knee after surgical ligament repair. Others have increased motion in the knee joint as the graft stretches over time.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider prior to the procedure.

How do I get ready for a knee ligament repair?

  • Your healthcare provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your healthcare provider may perform a complete physical exam to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Tell your healthcare provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your healthcare provider.
  • You will be asked to fast for 8 hours before the procedure, generally after midnight.
  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for some to drive you home.
  • You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
  • Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
  • Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during a knee ligament repair?

Knee ligament repair may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Knee ligament repair may be performed while you are asleep under general anesthesia, or while you are awake under spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. Your doctor will discuss this with you in advance.

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Generally, knee ligament repair surgery follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. You will be positioned on the operating table.
  4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  5. The skin over the surgical site will be cleansed with an antiseptic solution.
  6. The doctor will make several small incisions in the knee area.
  7. The doctor will perform the surgery using an arthroscope (a small tube-shaped instrument that is inserted into a joint). The doctor may reattach the torn ligament or reconstruct the torn ligament by using a portion (graft) of the patellar tendon (that connects the kneecap to the tibia), the hamstring tendon (from the back of the thigh), or other autografts. The tendon graft may come from the person (autograft) or from an organ donor (allograft).
  8. The doctor will drill small holes in the tibia and femur where the torn ligament was attached.
  9. The doctor will thread the graft through the holes and attach it with surgical staples or screws. Bone eventually grows around the graft.
  10. The incision will be closed with stitches or surgical staples.
  11. A sterile bandage or dressing will be applied.

What happens after a knee ligament repair?

After the surgery you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Knee ligament repair is usually done on an outpatient basis.

You may be given crutches and a knee immobilizer before you go home.

Once you are home, it is important to keep the surgical area clean and dry. Your healthcare provider will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your healthcare provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

To help reduce swelling, you may be asked to elevate your leg and apply an ice bag to the knee several times per day for the first few days. Your healthcare provider will arrange for an exercise program to help you regain muscle strength, stability, and range of motion.

Notify your doctor to report any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the incision site
  • Increased pain around the incision site

You may resume your normal diet unless your healthcare provider advises you differently.

Because of the limited mobility, it may be difficult for a few weeks to resume your normal daily activities. You may need someone at home to assist you. You should not drive until your doctor tells you to. Other activity restrictions may apply. Full recovery from the surgery and rehabilitation may take several months.

Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure

Stephen K. Aoki, M.D.

Patient Rating:

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Dr. Stephen K. Aoki, Associate Professor, specializes in hip and knee sports medicine. His clinical practice and research focus on both adult and pediatric sports injuries. Current interests include hip preservation/femoroacetabular impingement in the young adult, hip arthroscopy, the pediatric and adolescent athlete, ACL tears in children, patella... Read More

Robert T. Burks, M.D.

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Dr. Robert Burks, Professor, specializing in the field of sports medicine and shoulder surgery. His practice focuses on injuries to and degenerative conditions of the shoulder and knee. Dr. Burks graduated from St. Louis University School of Medicine in 1978. He completed his orthopedic residency at the University of California at San Diego and sub... Read More

Joy L. English, M.D., RMSK

Joy English, MD, is a member of the Sports Medicine Division and the Medical Director of the Orthopedic Injury Clinic within the Department of Orthopaedics at the University of Utah.  During her daytime clinics, Dr. English enjoys providing care for patients with a variety of athletic conditions and spends a portion of her time performing both fluo... Read More

Specialties:

Emergency Medicine, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Christopher A. Gee, M.D., M.P.H.

Patient Rating:

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Dr. Gee is a Board Certified Emergency Medicine and Primary Care Sports Medicine Physician who focuses on the treatment of non-operative musculoskeletal conditions at the University Hospital, South Jordan Health Center, and University Orthopedic Center. He is a member of the teaching faculty at the University Hospital and educates resident physicia... Read More

Patrick E. Greis, M.D.

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Dr. Patrick Greis, Board Certified Professor of Orthopaedic Surgery, joined the Department of Orthopaedics in March of 1997 and specializes in sports medicine, knee and shoulder surgery. His interests include all aspects of knee and shoulder surgery, including arthroscopic surgery, ACL reconstruction, shoulder instability, rotator cuff issues, arth... Read More

Pamela A. Hansen, M.D.

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Dr. Pamela A. Hansen is an associate professor in the Division of Physical Medicine and Rehabilitation who specializes in musculoskeletal and spine rehabilitation.  She holds Board Certifications from the American Board of Physical Medicine & Rehabilitation and a sub-specialty Board Certification in Sports Medicine.  Research interests include exer... Read More

Specialties:

Cancer Rehabilitation, EMG, Non-operative Musculoskeletal Disorders, Physical Medicine & Rehabilitation, Spine, Sports Medicine

Locations:

Huntsman Cancer Institute
Linda B. and Robert B. Wiggins Wellness Center
(801) 587-4585
University Orthopaedic Center (801) 587-7109

Emily J. Harold, M.D.

Patient Rating:

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Emily Harold, MD, is a board-certified physician specializing in sports medicine. She received her bachelor's degree from Washington University, where she also played basketball and contributed to three National Championship teams. Dr. Harold received her medical degree from Ohio State University, and went on to complete a fellowship at the Clevela... Read More

Richard W. Kendall, D.O.

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4.6

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Dr. Richard W. Kendall is a Physical Medicine and Rehabilitation physician who specializes in diagnosis and rehabilitation of back and neck pain using exercise, therapy, interventional spine procedures and electrodiagnostic testing. He has special interest in back and neck pain in cyclists, triathletes, endurance athletes and musculoskeletal rehabi... Read More

Travis G. Maak, M.D.

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Dr. Travis Maak’s practice is focused on sports medicine and arthroscopic treatment of the hip, knee and shoulder. He is the Head Orthopaedic Team Physician for the Utah Jazz and Assistant Professor in the Department of Orthopaedics at the University of Utah. Dr. Maak is originally from Salt Lake City and a graduate from Stanford University. He co... Read More

David J. Petron, M.D.

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Dr. David Petron, Assistant Professor (clinical) is a primary care orthopaedic/sports medicine specialist. He originally trained in family practice and then completed a fellowship in primary care orthopaedics and sports medicine at Michigan State University. Dr. Petron is the Director of Primary Care Sports Medicine and the team physician for the U... Read More

Amy P. Powell, M.D.

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Dr. Amy Powell, Assistant Professor, (clinical) is a board certified Sports Medicine physician serving as a team physician for the University of Utah Utes. She specializes in the care of athletes and active people of all ages, focusing on attaining and maintaining a patient’s physical performance goals. Dr. Powell received her medical degree from t... Read More

Specialties:

Foot and Ankle, Shoulder, Sports Medicine

Locations:

University Orthopaedic Center (801) 587-7109

Stuart E. Willick, M.D.

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4.7

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Stuart Willick, MD is a fellowship trained, board certified sports medicine physician. He has worked with numerous elite sports organizations, including the University of Utah, the United States Ski and Snowboard Association, US Speedskating, the US Bobsled and Skeleton Federation, and the International Olympic and Paralympic Medical Committees.  D... Read More

Specialties:

Concussion, Sports Medicine

Locations:

Redstone Health Center (435) 658-9262
University Orthopaedic Center (801) 587-7109
University Orthopaedic Center 590 Wakara Way
Salt Lake City, UT 84108
Map
801-587-7109
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84095
Map
801-213-4500
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