Treatment Options For ACL Damage and Pain

Marc Darrow, MDMarc Darrow, MD

When faced with the ACL treatment decision, a patient will usually weigh two options, surgery or no surgery. There are a lot of opinions offered as to which path the patient should take. Every ACL injury is unique to the patient, so this question is best asked of your physician and better yet, a second opinion physician. ACL surgery is an elective surgery and many athletes have chosen not to have it.

If the no surgery alternative is chosen, then the patient will then try to determine a course of action that will allow them to continue running or participate in other sports. Generally, you will know if you can run on your damaged knee or not by the amount of knee strength you still have and the level of pain you experience. Because the ACL is mostly used in supporting the knees in movement such as those found in playing tennis and basketball, (jumping, quick stopping, fast change of directions), these activities are usually stopped for fear of further damage. For the most part, many ACL damaged individuals are able to continue running or jogging and participating in certain sport activities.

Another option

Unfortunately doing nothing to a damaged ACL can also lead to physical problems later. Studies have shown that left untreated, knee weakness, arthritis, and other structural damage that may lead to a need for knee replacement may occur. Of course, in this situation, running will no longer be an option.

A very conservative treatment we specialize in is Prolotherapy because it works on most knee problems with excellent results. Prolotherapy is a simple injection of dextrose and a local anesthetic, like those used in dentistry work. What the dextrose does is start a very small inflammatory response in the body. Inflammation kicks up the immune system, the immune system brings up fibroblasts which are small cells that produce collagen. In other words the collagen metabolism spoken of before is stimulated. A few injections is of course a lot less invasive than surgery, not to speak of the rehabilitation effort following surgery in comparison.

Only in the case of a completely torn ligament is prolotherapy somewhat limited. If there is a partial tear (sometimes on MRI these may look like complete tears) Prolotherapy maybe able to reconstruct the ligament and strengthen the joint. But even with a complete tear, Prolotherapy is extremely beneficial because an impact with enough force to completely rupture a ligament will also loosen the entire knee structure. Prolotherapy in this situation can strengthen the surrounding tissues giving the patient a better chance of long-term success.


ACL Injury and Reconstruction

Anterior cruciate ligament reconstruction failed to restore normal rotational knee kinematics during dynamic, functional loading and some degradation of graft function occurred over time. These abnormal motions may contribute to long-term joint degeneration associated with ACL injury and reconstruction.”

Tashman S, Kolowich P, Collon D, Anderson K, Anderst W.Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res. 2007 Jan;454:66-73.

ACL injury treated with rehabilitation and early activity modification

Researchers writing in the American Journal of Sports Medicine say “Good functional performance and knee muscle strength can be achieved and maintained over time in the majority of patients with ACL injury treated with rehabilitation and early activity modification but without reconstructive surgery.”

Ageberg E, Pettersson A, Fridén T.15-Year Follow-up of Neuromuscular Function in Patients With Unilateral Nonreconstructed Anterior Cruciate Ligament Injury Initially Treated With Rehabilitation and Activity Modification: A Longitudinal Prospective Study. Am J Sports Med. 2007 Aug 17.

Knee Bracing?

Researchers writing in Clinical Orthopaedics and Related Research report on the effectiveness of knee braces after ACL reconstructive surgery.

Bracing after anterior cruciate ligament (ACL) reconstruction for rehabilitation and functional return to activities has been a common practice.

Clinicians have believed braces improve the outcome of ACL reconstruction by improving extension, decreasing pain and graft strain, and providing protection from excessive force.

However, we hypothesized the use of these braces could not be rationalized by evidence of improved outcome including measurements of pain, range of motion, graft stability, or protection from injury.

Wright RW, Fetzer GB. Bracing after ACL reconstruction: a systematic review. Clin Orthop Relat Res. 2007 Feb;455:162-8.