The ACL and the Posterior Cruciate Ligament (PCL) are inside the knee joint in a crossed pattern. They extend between the femur (thigh bone) and the tibia (lower leg bone). The ACL controls rotation and forward motion of the tibia while the PCL controls backward motion.

The doctors and other care providers at Cascade Orthopaedics are skilled at diagnosing and treating these injuries as well as other sports, work and home injuries to upper and lower extremities.

Most of these injuries occur without contact with other players but injuries caused by contact as in clipping or being tackled from the side can result in ACL tears along with other injuries as torn collateral or side ligaments, torn menisci, bone contusions and fractures. It is important to seek medical attention in order to fully diagnose these injuries. A complete examination may reveal significant instability. X-ray images may show a fracture and MRI scans will help determine the severity of an ACL injury, particularly complete or partial tears, meniscus (pad or joint cushion) tears as well as other ligament injuries, bone contusions or crush injuries. Complete ACL tears usually result in significant looseness or instability which if untreated can lead to meniscus tears, loosening of other ligaments and eventual arthritis. A very loose sloppy knee functions poorly and can perform unreliably.

After evaluation and depending on the extent of the injury, immediate treatment usually involves limited activity, partial or no weight bearing, ice, elevation and bracing.  Partial tears can be treated conservatively with activity modification, rehabilitation and bracing in order to allow healing of the ligament and eventual return to full activities. Meniscus tears may require arthroscopic repair or partial excision or removal.

Complete ACL tears usually require reconstruction of the ligament in athletes and other people whose activities place high demands on their knees, such as court and field sports, skiing, hiking on rough terrain and home and work activities that require pivoting and cutting, steep hills and slippery surfaces. Walking straight ahead, swimming and road biking are safer activities for a cruciate deficient knee. General medical condition and age also may be determining factors as well as underlying significant knee arthritis which may preclude surgery.

Reconstruction of an ACL is performed arthroscopically as an outpatient and requires placement of a graft, frequently a hamstring tendon or portion of the patient's own patella tendon. This is followed by a period of limited activity, rehabilitation with physical therapy along with a home program of exercises and conditioning where most patients are eventually able to return to full activity.

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