Without fail each fall, I will receive a phone call from one of our trusted athletic trainers (ATCs) that proceeds as follows.
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ATC: “Hello, doc. Have a kid here, twisted his knee during the game Friday night and was unable to continue. The knee became more and more swollen over a 24-hour period. It is giving out on him when he walks around the house.”
Doctor: “What grade is he in?”
Doctor: “OK, let’s get him in and evaluated.”
This is a scenario that can happen to either gender, in any sport and on any surface. And this is a fairly common story of how a tear of the anterior cruciate ligament (ACL) happens.
ACL injuries are prevalent in the young, active population. They present as above, most commonly during a non-contact, twisting injury that progresses with knee swelling over a 24-hour period. They can also happen during contact and collision sports.
The mechanism for this injury is a subluxation (shifting) of the knee as the tibia (shin bone) translates and twists on the femur (thigh bone). In this scenario the force of the shifting exceeds that which the ligament can withstand and the ligament tears. This force can be applied to the knee with a simple change of direction, an awkward landing from a jump or with a collision with a teammate.
Every knee injury with swelling is not an ACL tear. Other injuries that must be ruled out are meniscus tears, dislocation of the kneecap, and other ligament injuries. Determining the nature of the injury is done with a good history and physical examination first, followed by an X-ray and MRI if indicated. If it is an ACL tear, reconstructive surgery will be needed.
A question that undoubtedly comes up is should the teen continue to play sports with an anterior cruciate ligament tear. Studies have shown that young athletes that continue to play running, cutting or jumping sports on an ACL-deficient knee have a higher risk of meniscus damage at the time of the reconstructive surgery. This injury to the meniscus may not be fixable and can lead to cartilage damage and predispose the knee to early wear. Thus, it is recommended that the young athlete with an ACL tear discontinue participating in sports.
The challenge with this conversation is that these injuries are season ending because recovery after ACL surgery is about six to nine months. Returning to play without proper rehabilitation to the leg and reconditioning may lead to further/repeat injury. The good news is that approximately 80 to 90 percent of athletes will return to their prior level of competition with proper rehabilitation following an ACL tear and reconstruction.
James Rosneck, MD, is a Cleveland Clinic sports medicine orthopaedic surgeon specializing in hip, cartilage and knee injuries. To make an appointment with Dr. Rosneck or any of our sports medicine surgeons, please call 877.440.TEAM.