Knee Injuries: The ACL
By Dr. Howard Gelb
Anterior cruciate ligament (ACL) injuries are increasingly common in younger athletes, especially in female athletes. The ACL is one of four major ligaments that stabilize the knee. Its main function is to prevent injury to the knee cartilage (meniscus-cushions and articular surface). Without an ACL, the knee becomes unstable with twisting turning sports. Injury to the ACL is usually associated with a non-contact twisting injury. ACL tears are usually diagnosed by a combination of history and physical exam. In a majority of the cases, the patient reports planting the foot while twisting the knee and falling to the ground. Most people recall hearing a pop in the knee at the time of injury.
Usually the patient cannot return to the sport the same day as the initial injury and the knee swells within the first 24 hours. The Lachman test is the most important physical exam finding that aids in the diagnosis of a tear. There can be associated injuries to other ligaments as well, such as the MCL. An orthopedic surgeon trained specifically in sports medicine is usually more experienced and accurate in this diagnosis. MRI can be useful to confirm the diagnosis and assess the meniscal cartilage. The meniscus is damaged almost 50% of the time in association with an acute ACL tear.
Treatment of an ACL tear is patient specific but includes reconstruction of the injured ligament using one of several arthroscopic surgical techniques. It is essential that the meniscus be repaired if possible in the young athletic patient in order to prevent future damage to the knee. Certified in Sports Medicine, Dr. Gelb specializes in the treatment of ACL injuries in both adult and pediatric patients.
Dr. Howard J. Gelb is a board certified orthopedic surgeon specializing in adult and pediatric sports medicine and arthroscopic surgery. He has been in private practice since 1995.
Sports Medicine & Orthopaedic Center