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ACL injuries: When surgery is needed, and when it's not for treating the knee injury

6abc Digital Staff Image
Wednesday, January 4, 2023
ACL injuries: When surgery is needed, and when it's not
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We know of ACL injuries from pro athletes. However, non-athletes suffer them often, too, and most don't involve direct contact.

AMBLER, Pa. (WPVI) -- We often hear about pro athletes with ACL injuries.

But non-athletes suffer these knee injuries, too, as a young mother from Ambler, Pa., shared with 6abc.

Cristine Pagan makes a point of being active with her three children.

But their trip to a trampoline park to celebrate the last day before school didn't end well.

"I got on the trampoline and thought, hey, I could jump as high as they could. And well, my body told me I couldn't," recalls Pagan.

When Pagan landed, she felt her knee pop.

"It was such a jolt. And then the pain just kind of went over my body," she remembers.

Pagan had torn her right ACL - anterior cruciate ligament - as well as the right and left meniscus - the cartilage pads which cushion the knee joint.

She says she also tore some ligaments supporting her kneecap.

Dr. Vishal Saxena, a Temple Health orthopedic surgeon, says the ACL is vital in stabilizing the knee.

"Its main function is really to prevent the shinbone - the tibia - from going too far forward against the femur, but it also helps to give rotational stability," says Dr. Saxena.

He says the ACL can tear even without a direct blow.

"The foot gets caught, and then you have your whole body weight that's shifting awkwardly on that knee," he notes.

And women like Pagan face a greater risk.

"Females basically have a smaller notch where the ACL sits," says Dr. Saxena.

Women also tend to have stronger quadriceps and weaker hamstring muscles - an imbalance adding to their risk.

Surgery is usually a must for athletes, who need to do cutting and pivoting moves.

But non-athletes may not need it.

"They may just do mostly straight line activities - walking, going up and down stairs, even exercising - going to the gym lifting weights," according to Dr. Saxena.

Because of the extensive damage to her knee, Pagan needed surgery, plus physical therapy before and after to strengthen muscles supporting the ACL.

The process took a year, but it's been worth it.

"Being able to run with my children again, being able to play with them and not have to miss a beat, because of the care I got from Dr. Saxena," she says with a smile.

"If I didn't have that surgery, if I didn't get to meet Dr. Saxena, I don't know what I would have done," Pagan says.

"I'd rather go through the pain of having three more children than go to the knee pain I felt," she adds.

Dr. Saxena says ACL surgery has usually involved constructing a new ACL, usually from a muscle or a cadaver ligament.

However, up to 20% of patients aren't happy with their ACL reconstruction, usually saying it just doesn't "feel like a normal knee."

For that reason, Dr. Saxena says there's extensive research in repairing these ligaments, "because that native ACL has those proprioceptive sensors," giving patients a better sense of the placement and movement of their leg.

"There's some data that has indicated pretty good results among adolescents and teenagers," says Dr. Saxena, noting it is also being investigated among adults.