Tear > Treatments
Non-operative treatment for
ACL (anterior cruciate ligament) tears may include the
use of a brace in conjunction with exercises designed
to strengthen the muscles around the knee. Instead of
relying on the ACL for support, you will need strong
hamstring muscles in the back of your thigh and quadriceps
muscles in the front of your thigh to stabilize your
knee so it can support your weight. Your physician may
initially prescribe a rehabilitative knee brace, designed
to stop your knee from flexing past a certain point.
These stiff, light-weight braces are restrictive but
allow some motion. As you regain strength and stability
in the knee, your physician may recommend a functional
knee brace, which is more flexible and designed to be
worn during daily activities. You need to reduce two
main forces from stressing your knee during rehab and
daily activities: rotation (the shinbone and thighbone
twisting in opposite directions) and translation (the
shinbone moving forward in relation to the thighbone).
Off-the-shelf functional knee braces are sized according
to the circumference of your thigh six inches above
your kneecap. Custom braces are fit by measuring your
thigh, knee, and calf with an instrument provided by
the brace manufacturer. Choose the longest possible
brace that fits without restricting your movement. More
durable brace materials are more important if you plan
on being active. Be sure a physician trains you to position
the brace hinges around your knee so it bends normally.
Check the brace's position regularly and reposition
the brace if it slips. Do not rely on the brace for
support. Be cautious when moving and be prepared to
limit your involvement in physical activities. There
is no evidence that wearing a brace prevents injury.
POST INJURY WEEK
You will likely
feel pain and discomfort for the first few days after
the injury, and your doctor will prescribe pain medications
as needed. These will likely be mild, over-the-counter
painkillers such as ibuprofen or acetaminophen. Rest
your knee as often as possible, elevating it above your
heart level, and icing it for between 20 and 30 minutes
a few times a day to reduce pain and swelling. As soon
as possible, you should begin using a CPM (Continuous
Passive Motion) machine while in bed. Your physician
usually can arrange to get you a CPM. This flexes and
extends the knee and prevents the joint from becoming
stiff due to inactivity. You are encouraged to begin
walking and putting some weight on your knee immediately
with the aid of crutches and a rehabilitative brace.
You may need to use crutches for between two days and
three weeks. Within two weeks, the majority of patients
should be able to walk carefully without crutches. Be
careful to avoid activities that put your knee at risk.
Anything in which you might twist your knee can lead
to further injury. With proper physical therapy, people
who lead more sedentary lives can often return to work
within a week, and after four or six weeks most can
resume driving then. More active people may need more
time to recover before returning to work.
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after your orthopedic
evaluation. Non-operative recovery from a torn ACL takes
an average of between four and six months with 45-minute
exercise sessions three days a week. Though everyone's
rehab program is slightly different, physical therapy
for a torn ACL follows a general pattern. The first
three weeks are usually spent restoring a full range
of motion to your knee and recovering to the point of
being able to walk without crutches. Movement may initially
be painful, but it is important to not allow your knee
to stiffen. Rehab progresses to resistive exercises
to strengthen muscles around the knee. During this time,
you should be able to resume functional activities like
stair climbing, single leg support, swimming, and driving.
After about three months, the emphasis will change from
strengthening to functional training, as you begin exercises
specifically geared for your activities and lifestyle
to regain balance and control over your body.
These may include more vigorous warmups on a stationary
bike, elliptical trainer, or treadmill. You should be
able to return to normal activities after about four
months. Physicians usually suggest that you continue
strength training even after your knee has been rehabilitated.
Your doctor will likely check your ACL for strength
and endurance. After your physician measures knee strength,
you may be able to exercise at full strength and compete
in your favorite activities. However, your ability to
exercise may remain limited to walking and light activity
even after rehabilitation. If your knee continues to
buckle and remains unstable after rehab, non-operative
treatment of your ACL tear may not have been effective.
You should consult your physician about undergoing a
more aggressive treatment.
strengthening exercises: Ligament injuries
Strengthening the hamstrings and quadriceps
muscles will help prevent further knee injury. The more
agressive and dedicated you are during rehab, the greater
ther chance you will maintain a stable knee. After up
to six months of rehab, your knee may feel strong but
your will not help stabilize you knee as it did before
the injury. You may be vulnerable to further injury.
Many of the exercises and activities that are popular
for fitness put stress on your knees. To prevent further
ACL injuries it is important to learn knee-sparing exercise
techniques by dividing your activities into three components:
living - the average person takes between 12,000 and
15,000 steps a day, exerting a force between two and
five times your body weight on your knees. After a knee
injury, take it easy on your knees during the day whenever
possible to save them for activities and exercise. Avoid
stairs when there is an elevator, take the shortest
path when walking, and consider wearing athletic shoes
designed to absorb shock.
strengthening/conditioning - activities themselves are
not a substitute for conditioning. It is essential to
adhere to the muscle strengthening program you learned
in rehab throughout the remainder of your life. The
best strengthening programs are low-impact and non-weight-bearing,
like stationary bikes and certain weightlifting programs,
so that the knees do not have to absorb shock.
- your sport or activity of choice helps maintain mental
and physical well-being, but it is not a conditioning
program. Sports that require twisting and quick direction
changes put great strain on your knee. Without surgery
to repair your ACL, you should avoid sports like basketball,
soccer, skiing, running, and football that stress your
A small amount of pain is normal
during physical activity, but if you feel so much pain
in your knee to warrant taking a painkiller before an
activity, you should consider cutting back or stopping.
Do not play through the pain after an ACL injury - it
may be a sign that your activity is putting too much
stress on your knee.
Some people feel safe wearing a knee brace after
an ACL injury, but if the brace is too tight, it can
cause added pain afterward an activity. If you do wear
a brace, wear one that has a kneecap hole or padding.
There is no evidence that braces prevent injuries, meaning
they are not a substitute for increasing your muscle
strength. Always consult your physician before buying
a knee brace.