3 Advancements in ACL Injury Reconstruction

Modern surgical techniques and advancements in physical therapy have made anterior cruciate ligament (ACL) reconstruction and recovery a much more manageable injury than in the past.

Whether you’re a devoted UCF fan cheering on Josh Heupel’s Knights, or just trying to stay in shape, the term ACL is rarely associated with good news. Your ACL is a main component of your knees, connecting the femur to the tibia. In the sports world, a torn ACL could mean your favorite Knight’s season is over; in your doctor’s office, it could mean 12 months of surgery, limited mobility and physical therapy.

A dynamic and varied exercise routine is key for UCF Knights fans to stay in shape. While recreational sports such as tennis, basketball or flag football are great for overall fitness, some of the movements during these activities could lead to an ACL tear.

Thankfully, gone are the days of an ACL tear being a career-ending injury for UCF athletes, along with scars crisscrossing the knee and a lifetime of limited mobility. With modern surgical and physical therapy advancements, ACL injuries, while still serious, are an obstacle that Knights fans and athletes can overcome with the right care.

AdventHealth physical therapist Sheila Klausner, a senior clinician in sports medicine rehabilitation, has been helping Knights players and fans overcome ACL injuries for 14 years. Klausner shares her expertise on all things ACL, including reconstruction options, the mental and physical hurdles associated with recovery and tips both for prevention and life after reconstruction.

Innovative ACL Reconstruction Options

A torn ACL can heal faster than ever before, thanks to three new surgical options: patellar tendon grafts, cadaver transplants and hamstring tendon grafts. Klausner explains how each works, and how these innovative procedures benefit the UCF Knights and fans alike.

The Gold Standard: Patellar Tendon Grafts

Using your patellar tendon to repair a torn ACL offers some distinct advantages. Your tendon, with a portion of your bones attached to either end, is transplanted in this procedure. Your body knows how to heal your bones, accepts the transplant and gets to work healing after the transplant.

According to Klausner, “Your own patellar tendon is the best because you have your own bone as the anchors into the femur and tibia where the old ACL existed.”

The patellar tendon graft is considered the gold standard of ACL reconstruction and is the most common method currently used for athletes like the UCF Knights. And with minimally invasive arthroscopic procedures, only a few small incisions are required for AdventHealth doctors to complete this procedure.

The only downside of using your own patellar tendon is that it disrupts the natural function of the quadriceps, which must be addressed during rehabilitation.

Cadaver Transplants

While cadaver transplants can offer some of the best minimally invasive options, you do run the risk of your body rejecting the foreign tissue, despite modern sterilization techniques. Cadaver transplants are done using a variety of tendons and ligaments, including ACL, Achilles tendon, patellar tendons or hamstring tendons.

As Klausner explains, “Harvesting techniques have improved the design of the donor graft and sterilization, but the question lies whether the sterilization process may weaken the tissue.”

"Rehab may be easier at first because there is less pain, but motion and bending progression must be monitored not to overstretch the graft too quickly.”

Hamstring Tendon Grafts

While it uses your own tissue, hamstring grafts require what’s called “bone plugs” at either end of the tendon to enable it to attach to the femur and tibia. Over time, your body forms new bone around the “bone plugs,” making a solid anchor. The hamstring tendon is much longer than the ACL and is quadrupled over into a bundle to resemble the anatomy of the original ligament.

Rehabilitation: Training Your Brain

While Knights players may recover from an ACL reconstruction in as little as six to nine months, its more realistic for you to expect the process to be closer to a full year.

The difference in time frame is based on multiple factors. The Knights are generally in better physical shape than the average person to begin with, and are more accustomed to the training regimen required during rehabilitation. Couple that with the increase in hours per day Knights can devote to the process and the time variance in recovery makes more sense.

Body and Mind, Working in Harmony

A big part of the rehabilitation process is teaching the body and mind to function normally with whichever tendon or ligament is used for the repair. Injured Knights players must condition the body to strengthen the new tissue, while also conditioning the mind to trust its new equipment — a process Klausner calls training the brain. Hesitation and doubt are natural during the long process of rehabilitation but can be overcome with the proper plan from AdventHealth physical therapists.

According to Klausner, “The mental piece of the puzzle plays a big role in returning to top form. There can be a great deal of fear and apprehension about running, jumping, and planting or cutting maneuvers needed to participate at pre-injury levels.”

“Our rehabilitation program is designed to heal the athlete physically and mentally by designing exercises that challenge dynamic movement patterns. This allows them to feel and see that they can trust their legs again.”

Rehab Tailored to Your Needs

Rehabilitation methods vary depending on the type of reconstruction method used. For instance, using your own patellar tendon requires a specific set of physical therapy exercises to reteach the body how to move with the patellar tendon being disrupted.

To help you heal after ACL reconstruction, AdventHealth physical therapists customize specific sets of rehabilitation exercises to strengthen both the site of the harvested tissue as well as your new ACL. Klausner stressed that, your physical therapist must emphasize an accurate rehab program that assists in proper healing of the patellar tendon donor area.

“The rehab protocols have very specific plans for progressing to jumping and running and gradually building into agility training which develops multi-planar motions to mimic sports-specific movements patterns.”

Part of the new learning required is called proprioception, which means being aware of the position and movement of your body. Being conscious of your body’s movements during physical therapy helps build mental and physical confidence as you continue healing. Challenging the body during physical therapy to acclimate to its new reality in terms of strength and balance is a big part of training the brain that is necessary for your full recovery.

Preventing ACL Tears

Even though the ACL is a main component of the knee, other parts of the leg require focused training to minimize the chance of a tear. The hip and pelvis are key players in creating an environment where the forces exerted on the knee do not lead to injury. The proper strengthening of these upper leg muscles helps stabilize the knee, helping prevent ACL tears.

“Preventive exercises mostly focus on the hip and controlling the forces of impact into the knee joint,” Klausner says. Squats, lunges, and lateral band walks are all excellent movements to help strengthen the quadriceps, hamstrings and pelvic girdle muscles that protect the ACL.

“Momentum and body weight need to be controlled by the powerful muscles of the hip to stop the femur from moving into adduction and internal rotation,” Klausner says.

Along with exercise, choosing supportive footwear might sound like a good first step in protecting your ACL, but Klausner says not to rely too heavily on sports gear. “While footwear can be designed to slow down or prevent overpronation of the ankle joint, this shouldn’t be a first approach to prevention as the shoe can stretch or gradually breakdown. Emphasis should be placed on strengthening the muscles of the lower leg,” Klausner says.

Healing ACL Tears With Personalized Care

Your chance of an ACL tear can be minimized with a proper training regimen that focuses on strengthening both the larger muscles of your upper leg as well as the smaller muscles of the lower leg to create a strong, stable knee.

If you do experience an ACL tear, AdventHealth offers a variety of treatment options that, when paired with a little hard work and the proper physical therapy, can help you get back in top form. Every day, our physical therapists help the UCF Knights, and fans like you, heal from sports injuries in body, mind and spirit. Learn more or request an appointment today.