Why Did I Tear My ACL Again ?

Did I Just Tear My ACL Again?

You remember that horrible pop and you vividly remember the anxiety laden  trip to the operating room.  You remember thinking  how could that small cut on the front of my knee hurt so much.  The months of grueling rehabilitation and exercises  are etched in your memory forever… and you thought you had put it all behind you.

You anxiously return to the playing field, you twist and turn in pursuit — POP :-(  Your heart is pounding, your mind is racing … and that feeling at the bottom of your stomach is telling you that you may have injured your ACL once again.

Why Did I Tear My ACL Again !!

There are many potential reasons why you find yourself on the examing room table of your Orthopedic Surgeon once again.   Let’s review them with the hope that you will never have to deal with this horrific injury ever again.

1. The scientific literature is fairly clear on many of the reasons why some of you are at risk for developing an ACL tear.  In many it has to do with your landing mechanics, the orientation of their leg, and in women it has to do with their hormonal variations during their ovulation.  In many of you it was simply an injury that was going to happen — your mechanics are simply off.
2. You weren’t ready to return yet.  Many people are under the misconception that simply having the surgery and having your wounds and incisions heal is all that is necessary to enable you to return to sports after ACL surgery.  Nothing could be further from the truth.   By far the most important part of the ACL process is rehabilitation.  The most important people to work with during the ACL recovery process are your physical therapist and your athletic trainer.  Regaining your normal strength is only a  small part of the overall recovery process.  You will need to learn proper landing mechanics, jumping and pivoting mechanics and the entire lower half of your body will need to be properly educated to minimize the risk of another injury.  The psychological or emotional part of the recovery can not be ignored and plays a huge role in the successful return to the playing field.
3. Technical issues … or surgical failure.  An ACL reconstruction is a technically challenging procedure.  It requires attention to detail and a lot of experience.  We have discussed how to choose your ACL surgeon previously. Much of our recent literature on ACL injuries has focused on how ACL surgery should be performed and what tissue should be utilized to replace your ruptured ACL.  ACL surgery is not as simple as it may seem.  It is technically difficult and requires a significant amount of experience.  Volume matters.  You need to be under the care of a surgeon who performs many each year.  Unfortunately the average surgeon only performs a handful of ACL surgeries each year. Talk to your local trainer to see who they recommend.
4. Poor graft choice — The use of allografts or cadaveric grafts in young athletes is very controversial and most of us avoid it.  The re-injury rate is higher when compared to using your own tissue.   When you’re considering ACL surgery you will have many options about which tissue to use to surgically replace your torn ACL.  Choices include autograft or your own tissue, as well as allograft or cadaveric tissue.  No one particular graft is the right choice for everyone.  In women who tend to be quadriceps dominant and hamstring deficient, a hamstring tendon graft may not be the proper choice.  In an older athlete with relatively low functional demands an allograft might be a great choice.  A bone-patella tendon-bone graft is considered the gold standard by many for high level contact athletes.

There are many reasons why you may have re-injured your ACL.  Unfortunately the research shows that a very high percentage of athletes with an ACL tear will go on to re-tear the same knee or injure the ACL in the other knee.  There is a lot of science to support a strong ACL tear prevention program and more and more schools and clubs are starting to institute them.  A ounce of prevention is clearly worth it’s weight in gold.