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Anterior Cruciate Ligament (ACL)

The ACL is one of four ligaments in the knee that helps stabilize the knee joint. The surgeons at Virginia Mason Sports Medicine have more than 25 years experience treating ACL injuries and now perform more than 150 ACL reconstructions every year. Many studies show that surgeries performed at high-volume centers have better results and fewer complications. In the past 25 years, our surgeons have performed more than 3,000 ACL reconstructions at Virginia Mason Sports Medicine, making us one of the highest volume treatment centers in the region.

Tear of the ACL is a common sports injury. High-risk sports that involve contact or quick changes in direction may make an ACL injury more likely. These include basketball, volleyball, soccer, football and skiing.

Because of our involvement in the local soccer community, as well as being the team physicians for the Seattle Sounders FC, we see a large number of ACL injuries in soccer players of all ages. Along with soccer, many of our patients injure their knees skiing.

Injury to the ACL is the most common ligamentous injury of the knee. If you have an ACL injury that you are concerned about, you can schedule an appointment to speak with a sports medicine physician by calling (206) 341-3000.

Injury to Your ACL

ACL tears can occur from a contact or non-contact injury. Contact injuries involve a direct blow to the knee, often with damage to other ligaments as well. Non-contact injuries are the source of more than 70 percent of ACL ruptures. They usually occur during deceleration or pivoting of the knee.

Diagnosis of an ACL Injury

The diagnosis of an ACL tear is made in most cases by reviewing a patient's history and a thorough physical examination. Normally, an ACL injury is caused by a significant twisting or contact injury of the knee.

A high percentage of patients report that they heard a "pop" in the knee when the ligament ruptures. Swelling in the knee occurs in nearly all ACL tears. The swelling may not be significant and the onset may be delayed for 6 to 24 hours. However, swelling within 24 hours of an acute injury means there is blood in the knee and medical attention should be sought.

Studies have shown that more than 70 percent of injuries that develop swelling within the first 24 hours are associated with ACL tears. Therefore, an ACL tear should be suspected with acute swelling in the knee until proven otherwise.

At Virginia Mason, physicians will perform a thorough physical examination of the knee to confirm an ACL tear. This evaluation may include X-rays and/or an MRI of the knee.

Why Medical Attention is Critical After an Injury

Once the ACL is torn, it will not heal. Many patients no longer have functional use of the ACL because they did not have their injury properly diagnosed and treated.

These difficulties most often are repetitive instability with the knee buckling and giving way, and typically occur in 80 to 90 percent of patients who attempt to return to aggressive physical activities. If there are repetitive instability bouts, more damage can occur, including cartilage (meniscal) tears and the development of degenerative arthritis.

Treatment for ACL Injury

In active individuals, the recommended treatment for an ACL tear is typically surgical reconstruction. Current techniques have achieved well over 90 percent success in restoring stability to the knee. Repair of the torn ligament itself has shown a high failure rate, so the current standard of care is to reconstruct the ligament with another piece of tissue.

The surgeons at Virginia Mason Sports Medicine have extensive experience in the use of all currently used tissues for ACL replacement. These include the patient's own tissue, including patellar tendon grafts, hamstring grafts or quadriceps tendon grafts. Our surgeons also have extensive experience using transplant tissue, which avoids the need to remove portions of the patient's own normal tissue. Your surgeon will thoroughly discuss the pros and cons of each graft option and determine with you the best graft for your knee.

To schedule an appointment to speak with a sports medicine physician about an injury to your ACL or any other concern, call (206) 341-3000.