As an athlete cuts and changes direction, the anterior cruciate ligament (ACL) helps control excessive motion of the knee joint and keeps the lower leg from sliding too far forward. Of the four major ligaments in the knee, the ACL is the most commonly and severely torn in all types of athletes. With such an extreme injury present, doctors and professors of exercise and sports science have researched the best methods of reconstructing an ACL tear. Early research initially revealed that early ACL reconstruction did not effectively restore normal leg rotation, caused chronic instability and episodes of the knee giving away. After analyzing certain data though, other Swedish researchers decided to conduct a study looking specifically at patients whose ACL surgeries were completed early in their injury. After utilizing a specific type of surgery, the Swedish researchers observed and monitored these patients for two years. They found that if done correctly, early ACL reconstruction can actually help the knee and ACL heal stronger than before and re-obtain all of its normal function.
When an ACL is completely torn, the torn ends of the ACL must be replaced by a different structure and congruently sewn into position. There are multiple options for the type of graft used, the most common being grafts from the patellar tendon in the front of your knee and a hamstring tendon from the back of your thigh. In the past Bone-patellar tendon-bone surgery was deemed to be the gold standard of ACL reconstruction, but recent studies have shown that quadruple hamstring auto-grafts are equally successful in restoring the ACL’s tissues and strength. In this specific study the quadruple hamstring auto-grafts were used on the patients because it is a relatively newer surgery and evaluating the degree of rotatory instability and rotatory load capacities of the knee is easier. They also only completed the surgeries on patients that have not experienced chronic ACL insufficiency. This helped to eliminate any complications that could occur and data that could be skewed by irregular effects from the chronic insufficiency.
To begin the study the researchers used 14 consecutive patients with a median age of 24 years old and a complete ACL tear. The patients received the quadruple hamstring auto-graft surgery approximately 8-10 weeks after their injury and were evaluated periodically during the first two years post-surgery. During the study there were multiple routine repairs made to different parts of the tissue to aid in the correct healing of the new ACL. Every patient was rehabilitated to good leg control following standard rehabilitation protocol that any patient would receive, no matter the type of surgery used. For the data collection they evaluated the internal/external tibial rotation, the knee joints angulations, and the laxity present in the knee. To do this they used digital radiographs and computations of 3-dimensional coordinates to take their measurements and visually see the connections of the ligaments and the tissue. After the two years after surgery had passed clinical tests were utilized to determine the strength and durability of the newly repaired ACL. This was tested by leg jumps and hops, using single and both legs, and then recording the distances and level of comfort/pain experienced by the patients.
When the researchers examined the results of their study they found that ACL repair during the early stage of injury seemed to protect the knee from abnormal motion after the injury. They were also surprised to find that in certain areas they tested the patients’ knees performed better than before the ACL injury and reconstruction. 6-8 weeks after surgery the patients’ knees functioned normally in all categories of stability and strength and remained this way after the 2 years. 90% of the patients saw improvement in the scores of their stability while every patient’s internal tibial rotations had no significant difference in the intact and injured knees. The tibial rotation patterns seemed to be normal and showed that when you had surgery within 8-10 weeks of your injury you actually had just a strong or stronger knee. Every patient scored the same while performing weight bearing and load bearing activities before and after surgery. All of these findings showed enough persuasive evidence to support the fact that early surgery may be very beneficial for patients with ACL injuries.
When they had completed their research they compared and discussed other conclusive research that was conducted during or recently after their initial experiments. Another prospective study examined early ACL reconstruction within 3 weeks of the injury. There were four different groups that had surgery within forty eight hours, seven days, 3 weeks, and after 3 weeks. The results gave insight that although early reconstruction may be beneficial, there must be sufficient time in between the injury and surgery. This study showed that every patient that had surgery less than 3 weeks after the injury required even more surgeries and experienced a drastic loss of motion. The patients that had surgery after 3 weeks displayed similar results as the patients of the Swedish researchers, experiencing normal motion, laxity, and fully restored stability. This study gave further proof that from 8-10 weeks early ACL reconstruction is good for the patient and provided additional evidence to show that having surgery too early would have negative effects.
Here at UNC we perform many experiments and studies such as this one. The exercise and sports science program at Chapel Hill has multiple labs with the cutting technology to do in depth research such as this. One of our specific concentrations is in injury prevention. We use many of the same technologies they use to measure the pressure and stress that results on the body from different movements and activities as well as the effects that factors such as lack of sleep, poor dieting, and aggravated injuries can have on an athlete. These types of studies are going on in Chapel Hill and helping to keep athletes safe and allow for their top level of performance.
"ACL Graft Choice - Patellar - Hamstring." About Orthopedics. Team Legs. Web. 9 Feb. 2012.
Cluett, Johnathon. "ACL Injury Prevention - ACL Injury Prevention Tips for Athletes." Sports Medicine, Sports Performance, Sports Injury - Information About Sports Injuries and Workouts for Athletes. Web. 9 Feb. 2012.
Eriksson, Ejnar. "My Last Editorial for KSSTA." Knee Surgery, Sports Traumatology, Arthroscopy 16.6 (2008): 535. Print.
Quinn, Elizabeth. "ACL Injury Prevention - ACL Injury Prevention Tips for Athletes." Sports Medicine, Sports Performance, Sports Injury - Information About Sports Injuries and Workouts for Athletes. Web. 9 Feb. 2012
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