We interviewed renown orthopedic surgeon Dr. Nima Mehran to talk all about all things related to the anterior cruciate ligament or ACL. With over 200,000 ACL injuries per year and over half of those injured going to go surgery, the ACL is a hot topic within the performance and health fields alike. But what is the ACL? What does the ACL do? Do you need surgery after an ACL injury? We answered all those questions and more in this fantastic interview!
What is the ACL with Dr. Nima Mehran – Full-Length Interview
What is the ACL? What is its Purpose?
Anterior cruciate ligament connects the thigh bone (femur) to the shin bone (tibia) and crosses in front of the posterior cruciate ligament (PCL). It prevents the majority of anterior tibial translation (the tibia shifting forward relative to the femur). It also provides rotational stability, as well as, some side to side stability.
Surgical View of a Real ACL
How Do You Injure Your ACL?
Most commonly it occurs during sporting events as a non-contact injury. However, it can also occur in landings from jumps and contact injuries. Working on proper jumping and cutting mechanics is the most important aspect of rehab from an ACL injury and for preventing that injury in the first place! Check out this video to learn how to introduce and progressing cutting.
What Sports Have the Highest Rates of ACL Tears?
Basketball, soccer, football, skiing and martial arts.
How Can I Prevent Tearing My ACL?
Generally, the best thing to do is to work on mechanics and strength in hopes of avoiding noncontact injuries. You cannot plan for contact injuries, but if you work on hamstring strength, hip mobility, and landing mechanics that is a great place to start. Talk to a therapist and a performance coach to come up with a great plan for your deficiencies. Just remember, the hamstrings are the secondary stabilizer to the ACL so don’t skip those exercises on leg day. Also, plyometrics have been shown to help as well!
Deceleration and Landing Mechanics Training
Progressive Hamstring Strengthening
Are There Any ACL Injury Prevention Programs?
We helped put together the ACL injury prevention exercise programs for the orthopedic section of the APTA. Each program has 3 tiered phases. The 1st phase is the dynamic warm-up which addresses mobility restrictions and general primes the body and nervous system for more intense movement. The 2nd phase is your foundational strengthening phase. We cannot stress enough how important strength is to prevent injuries! In particular for reducing ACL injuries, the goal is to strengthen the quadriceps, hamstrings, glutes, and core. The 3rd phase is the movement coordination phase. You can have all the strength in the world, but if you don’t know how to properly move, deceleration, and cut all that strength isn’t doing you any good! This is the most important aspect of an injury prevention program.
Each phase is divided into multiple tiers based on difficulty level. Start with Tier I, and don’t move up to the next tier until you can complete all the exercises with perfect form.
ACL Injury Prevention – Field Version
The field version is for all your field sports like soccer, lacrosse, field hockey, etc.
ACL Injury Prevention – Court Version
The court version is for all of your court sports like basketball, volleyball, and racketball.
If I Tear My ACL, What Next?
You should see an orthopedic surgeon to discuss the pros and cons of ACL surgery. If you want to continue playing cutting or pivoting sports such as basketball, soccer, football, tennis, and martial arts you will likely need an ACL reconstruction. Even if you haven’t seen your surgeon yet or are unsure whether you should get surgery or not, you need to address the swelling immediately and work on regaining your range of motion and quadriceps strength. The ACL [P]Rehab exercises below are perfect for both operative and non-operative ACL injury rehabilitation. Get on it!
ACL Prehab Exercises
Does Everyone Who Tears Their ACL Need ACL Surgery?
Great question. The answer is no. If you do not participate in activities that require cutting or pivoting, you may be able to have success without surgery and concentrate on physical therapy and rehab. This is an important discussion to have with your local orthopaedist.
Surgical View of an ACL Reconstruction
If I Decide to Proceed with Surgery, Which Graft Choice is Best?
If you are indicated for an ACL reconstruction, picking a graft is an important part of your preoperative discussion. There is no perfect graft choice. They each have risks and benefits. The most important decision is determining if you should use your own tissue (autograft) or someone else’s tissue (allograft). If you are young and/or playing high-velocity sports autograft is generally the better option. However, if you have a lower activity level and are over 40 studies have shown that there is an equal success with an allograft.
If you and your surgeon choose autograft, there are several autograft options including patellar tendon, hamstring tendon, and quadriceps tendon. Each graft has its advantages and disadvantages, please see the video above for a full discussion of graft options.
If you and your surgeon decide on allograft, your surgeon will likely pick which allograft he has the most experience or comfort with.
READ: ACL Graft Options
How Long is the Recovery After an ACL Reconstruction?
This process can be 9-12 months. The most important part of recovery is that you listen to your physical therapist and surgeon and do not attempt to go back to sports until both feel that you are ready. Ideally, your physical therapist and surgeon are in communication and making decisions based on objective data points. Remember, not everyone has the same speed of recovery and you should never return until you feel physically, mentally and emotionally ready.
About the Co-Author: Dr. Nima Mehran
Dr. Nima Mehran, M.D., is an orthopedic surgeon specializing in sports medicine and joint replacements. He earned his undergraduate degree at the University of Southern California, attended the Chicago Medical School and was Chief Resident during his orthopedic surgery residency at Henry Ford Hospital. Dr. Mehran has published several scientific papers and has delivered numerous scientific lectures. He has been on the physician team for the USC Trojan Football team, Los Angeles Lakers, Los Angeles Sparks, Los Angeles Dodgers, Los Angeles Kings, and Anaheim Ducks.