When your tear your ACL (Anterior Cruciate Ligament) you tear the central stabilizing ligament in the knee. To best understand what you lose when you tear your ACL I would explain that without an ACL you can usually walk and perhaps even run relatively normally as long as you walk in a straight line. If, however, you plant your foot to pivot or change directions, your knee will probably feel as if it will give out on your or cause the knee to feel as if it won't support you. Sometimes the knee may feel as if it "hyper-extends".

ACL tears most often occur during running, cutting, or similar sports-like activities. It may however occur in all types of activities. When it occurs, often, but not always, you feel as if your knee gave out on you or hyper-extended. It is usually but not always associated with the sensation of a "pop". The knee tends to swell significantly within the first 24 hours.

More of than not, one can make the diagnosis merely by carefully listening to your explanation of what exactly happened at the moment you injured your knee (hyper-extension, "giving out", "pop", etc.)

As your physician, when I examine your knee, I can often tell that the ACL is torn by holding your femur (upper bone) stable with one hand while I move your tibia (lower bone) back and forth with my other hand. I compare the "looseness" of your injured knee to that of your uninjured knee. This will often be all that is needed to confirm the diagnosis.

X-rays are usually normal as x-rays display bones where as ACL is soft tissue. MRI studies can demonstrate the ACL but, unfortunately are not always accurate. The decision to treat a torn ACL is usually dictated by symptoms and physical findings rather than what one can see on an MRI.

ACL tears are usually associated with significant violence to the knee and other structures are often injured in addition to the ACL. MRI may be useful in understanding these additional injuries.

When an ACL tears, it usually stays torn. Partial tears of the ACL are very uncommon. Most ACL tears require treatment because of the instability that results from the injury. In order to return to a vigorous life style, reconstruction of the ACL is necessary.

1. Physical Therapy: A course of exercise therapy can help you overcome the initial swelling and stiffness that follows the injury but therapy or exercise along will not stabilize the knee.
2. Bracing: Custom ACL control braces may be helpful in controlling the ACL deficient knee. They usually do not work well enough to enable you to return to vigorous sports and, of course, only work when you are wearing the brace. Custom braces tend to work better than "off-the-shelf" styles. Braces tend to cost anywhere from $800 to $1,200. Often insurance companies will not pay for these braces so it is important to try and get insurance company prior authorization when considering trying a brace for this purpose. Some insurance companies will pay for a brace or surgery but not both.
3. Anti-inflammatory drugs, food supplements, injections: There is no evidence to indicate that these agents are useful in managing the unstable ACL deficient knee.
4. Surgery: Surgical reconstruction of the ACL is the only way to restore the stability to the knee. We use the term "reconstruction" rather than "repair" because when the ACL tears it usually literally explodes (thus the "pop") and results of trying to repair this "explosion" are not successful. Reconstruction describes the process of removing the debris of the torn ACL and making a new ligament out of something else.

1. First you must schedule the surgery with my office. The best way to do this is to call and ask for Anne (my personal assistant) or Kerry Nye (my surgical scheduler). Kerry will help put your schedule together with mine at a location consistent with the requirements of your insurance company.
2. If you have any significant medical risk factors such as heart disease, a current infection, lung disease or a history of blood clots, such issues may need to be addressed with your internist or primary care doctor prior to proceeding with surgery.

1. Your surgery will be done at a "Same-day-Surgery" facility which means you will go home the same day, usually an hour or two after the procedure is done. I perform these procedures at the Central Utah Surgical Center, Utah Valley Regional Medical Center and Timpanogas Regional Hospital.
2. You will be called the evening before surgery by the facility where your surgery is scheduled. They will ask you some questions and tell you what time to come to the facility the next day. They will want a phone number so they can notify you if the schedule changes.
3. IT will be necessary that you have nothing to eat or drink for 8 hours prior to the planned surgery. Failure to comply with this requirement dramatically increases the risks of anesthesia and will result in delay or cancellation of your surgery.
4. When you come to the facility, initial blood and other tests may be done to verify the status of your medical condition prior to the planned surgery. If you are female, a pregnancy test is routinely performed.
5. An intravenous line will be inserted into a vein in one of your arms. This will be used to administer medication intravenously.
6. You will be placed on a bed and your knee will be shaved. You will be asked to mark a "YES" on the knee that is to receive the surgery.
7. I will come and see you shortly before the surgery, answer any additional questions that you or your family members may have, and I will also put my mark on your leg. I want to take every precaution to make sure that I do the right procedure on the correct knee.
8. The anesthesiologist will come and talk to you about the anticipated procedure and the roll he will play in taking care of you. He also will answer any questions you may have.
9. At the appropriate time you will be moved to the operating room where you will be given an anesthetic and the procedure will be performed.

1. The knee will be painted with antiseptic solution to reduce the risk of infection. You will also be administered antibiotic medication through your intravenous line for the same purpose.
2. I will make three small puncture wounds in the front of your knee.
   • One is for the scope or camera which allows me to see the inside of your knee.
   • One is for the instruments I use to remove the torn part of the meniscus.
   • One is for a small fluid drain tube.
3. I will carefully examine the interior of your knee, confirm whether or not the ACL is torn as well as thoroughly examine the interior of the knee looking for possible associated injuries.
4. I then remove the remnants of the torn ACL and reconstruct the ACL using one of several possible sources of tissue that can be used as a graft to reconstruct the torn ligament.
5. If a "patellar tendon graft" is used, a 1-2 inch incision is made over the front of the knee to harvest the graft. If a "hamstring" graft is used, a 1-2 inch incision is made slightly below the knee to harvest the graft. If a cadaver graft is used, a separate incision to harvest a graft is not necessary.
6. If there are other problems encountered in the knee such as a torn meniscus or an area of surface cartilage injury I will treat those at the same time UNLESS treating those unanticipated conditions would significantly alter your anticipated course of recovery.
7. At the end of the procedure, I remove the instruments, apply "steri-strips" to the incisions, apply gauze pads and a Polarcare pad followed by an Ace bandage and a simple knee brace A femoral nerve block is often applied by the anesthesiologist to reduce the pain associated with the surgery.
8. You are then moved to the recovery room where you continue to awaken from the effects of the anesthesia. Once you have sufficiently awakened, you will get up with crutches, go to the bathroom, eat a snack and drink fluids prior to being released to go home. You will be instructed in use of the Polarcare unit which applies ice water around your knee to reduce pain and swelling.

1. You will feel sore and not want to do much. Stay down, keep your foot elevated, use the Polarcare to cool down the knee and use the medication provided as needed.
2. The prescriptions given you after surgery will usually include:
   1. Percocet for pain
   2. Valium for muscle spasms
   3. Phenergan for nausea control
3. You will be given a prescription for physical therapy which should start the day following surgery. Please call the indicated therapist, tell them I reconstructed your ACL and that you are to start your therapy the next day following surgery. If you have trouble getting an appointment please call me such that I can facilitate the start of your therapy.
4. My assistant, Anne, will call you the next day after your surgery to make sure you are doing O.K. to make sure you have started your physical therapy and to make sure your prescriptions are appropriate and schedule a follow-up appointment in 7 - 10 days.
5. Keep the knee dry for the first 3 days following surgery. On the 3rd day it is OK to get the knee wet in the shower but do not soak it in the bath tub. If you wish to take a bath prior to the 3rd day, keep the knee out of the water.
6. It is good to use the knee, gradually work on bending the knee and try to get back to normal. I expect you to limp about for 3-4 days, to be walking normally within a week and to be recovered within a month of the surgery.

1. It is my routine to visit briefly with you and/or your family following your surgery before you go home. I explain what I found and what I did. You will probably not remember any of this but hopefully your family will remind you of what I said.

1. Either I or my P.A. (Doug) will see you in the office about a week following your surgery. We will check your knee, review your surgery including providing you with copies of photos taken of the inside of your knee. I am not the greatest photographer but I try to at least obtain photos that demonstrate what was wrong and what I did (before and after) photos. I will also describe appropriate activities, exercises and rehabilitation efforts that should be performed.
2. I will continue to check on your progress and educate you regarding appropriate activities. I will not release you to return to sports or similar activities for at least 5 months following your surgery and probably longer. The knee is usually ready by 5 months however the supportive muscles are rarely ready that soon.

1. You will go home from the hospital with a temporary knee immobilizer. You may remove it as you wish. It is only designed to put the knee at rest and help you the first few days.
2. Later you may wish to use a hinged knee brace. Many feel more secure during the first few weeks of rehab with such a brace.
3. I will prefer that you use a custom ACL brace during the first year after surgery when competing in contact sports. Evidence suggests that this may reduce the likelihood of injury and protect the graft reconstruction of the ACL.