Frequently Asked Questions
Note: Injuries and conditions vary. The answers to the following questions are not meant as medical advice. Injuries and conditions vary depending on other factors and should be discussed with your medical professional.
ACL (anterior cruciate ligament)
Do females tear their ACLs more than males?
Yes, but not because they are female. The research we have done over the past 25 years tells us that the size of the notch in the knee is the primary reason that some people are more likely to have an ACL tear than others. The notch inside the knee is where the ACL is located.Our research shows that the smaller a person’s notch is, the more likely they are to tear their ACL. A male with a small notch is just as likely to tear their ACL as a female with the same notch size. It also works the other way around; females with large notches are no more likely to tear their ACL as a male with the same size notch.
Can kids with open growth plates have an ACL reconstruction?
Yes, because our surgical technique does not disrupt the growth plate. However, kids need to be at a certain stage of their growth. This will be determined at your evaluation.
How and why do ACL tears occur?
ACL tears usually occur when a person lands wrong from a jump or they plant their foot to change direction.
Is it possible to partially tear my ACL?
Technically, an ACL can be “partially” torn but what is important is that the ACL does its job and provides stability to the knee. If the ACL cannot prevent the shin from coming too far forward, the knee is unstable. If the knee is unstable, it does not matter if the ACL is fully or partially torn.
Why don’t ACL tears heal without surgery?
When the ACL is torn, it separates and the frayed ends do not touch. Since the ends do not touch, they cannot grow back together.
How soon after ACL reconstruction will I be able to walk without crutches?
You can start walking short distances the day after your surgery, but if you are feeling dizzy or light-headed, you can use crutches to help you walk. Your therapist or trainer will work with you to make sure you can walk without crutches at your appointment one week after surgery.
When will I be able to go back to my day to day activities after ACL reconstruction?
After ACL reconstruction, you will be on bed rest for one week to keep your knee from swelling. This helps you improve your range of motion more quickly. You can gradually start standing and walking more during the second week as long as you keep your swelling down. Your therapist or trainer will teach you how to watch your swelling. You will also be taught how to change your activities if you develop increased swelling.
How often do I have to go to physical therapy after ACL reconstruction?
You are taught how to do most of your exercises on your own, but will come into our office for check-ups with your trainer or therapist on a regular basis. These visits allow us to check your progress and make changes to your program. Usually patients come in at one week, two weeks, one month, two months, four months, six months, and one year after surgery. Sometimes patients come in a little more often if needed.
When will I return to sports after ACL reconstruction?
It depends on when you get your strength and range of motion back and you have no swelling. On average, our patients return to their sport at about 4-6 months after surgery. This all depends on the person and the sport.
Pain and Stiffness
Is it normal for my knee to hurt after playing basketball?
If both of your knees have some soreness, it may be because you have changed or increased your activity. If one knee is sore and you did not injure it, you may want to talk to your doctor if it does not get better with time.
When do I call a doctor about my knee pain?
You should talk to your doctor if you have knee pain that does not get better over time or if you have swelling that does not go away.
What does stiffness in my knee mean?
Stiffness in your knee could be a number of things or it could be normal for your knee. Stiffness in your joints could be from medication you are taking, early signs of arthritis, swelling, or other health issues. If the stiffness limits your normal activities or if there is swelling and/or pain that gets worse, you should talk to your doctor. Often times, stiffness in the knee can be improved with rehabilitation.
Why do you use the patellar tendon graft?
Several graft choices are available for an ACL reconstruction. We use the patellar tendon because it has a higher success rate than the other graft options available. It is the strongest type of graft found in the body and is just as strong as a normal ACL. The other benefit is that the tendon will grow back after taking the tissue out to create the new ACL. This means that the patient will not have permanent strength loss due to the graft harvesting process.
What about other grafts like hamstrings or allografts?
Hamstring grafts are not as strong as patellar tendon grafts. The area where the hamstring was taken from does not grow back and leaves the hamstring weaker than it was before surgery.Allografts, or cadaver grafts, are not taken from the patient’s own body. There is a higher failure rate with allografts. Since they heal slowly, patients cannot get back to their activities as fast.“I have performed more than 6000 ACL reconstructions. I prefer to use the patellar tendon graft because it allows for quick and predictable bone-to-bone healing, is viable throughout the entire postoperative course, and can respond to stress during rehabilitation. Although any biological graft that is properly placed in the knee can achieve the same stability after surgery, the patellar tendon graft may allow for the fastest postoperative rehabilitation program because bone-to-bone healing is quicker than tendon-bone healing.” – K. Donald Shelbourne MD
Why doesn’t the Shelbourne Knee Center use screws to fasten the ACL graft in place?
The new ACL graft is made up of tendon in the middle with small pieces of bone on each end. These bone plugs fit tightly into the tunnel that has been drilled into the thigh bone and the shin bone. The bone plugs heal to the bone around it, like how a bone fracture would heal. We use plastic buttons on each end of the tunnels to hold the graft in place while the bone plugs are healing.
I’ve been told that I have arthritic knees without much space left between the bones, is there anything that can be done to open this space up again?
Unfortunately, once the joint space is narrowed, there isn’t any way to “open it up” again. Our research and experience has shown us that many times, arthritis is accompanied by joint stiffness that makes the knee feel worse. By using a directed rehabilitation program to resolve the stiffness, our patients have been able to achieve significant reductions in their pain level and significant improvements in their level of function. If satisfactory gains are not made with rehabilitation, total knee replacement may be an option.
When is it safe to drive after surgery?
In general, most people return to driving between one and two weeks after surgery. This is a general guideline. Your physician and physical therapist will help you decide when it is safe to return to driving.
Why do some people have surgery because of a torn cartilage and some don’t?
“Torn cartilage” usually refers to a meniscus tear. Tears can be caused by injury or deterioration as a person gets older. Sometimes the pain and swelling caused by a meniscus tear goes away without surgery. It is okay to not remove torn cartilage as long as a patient can maintain equal range of motion and not favor that leg, causing the knee to become bent/deconditioned. Other times, surgery is required because the meniscus tear continues to cause problems. The best form of treatment will depend on several factors such as the type and location of the tear, and the severity of symptoms. Your physician will discuss your treatment options with you and work with you to find the plan of care that best fits your needs.