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ACL Re-Tears in Young Women

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The Anterior Cruciate Ligament (better known as the ACL) is one of four major ligaments inside the knee that is responsible for maintaining the joint’s stability during activities like jumping, turning, and pivoting. Because almost all sports require athletes to perform these type of actions, injuries and tears to the ACL are more common than not. In fact, ACL injuries are the most common ligament injuries not only of the knee, but of the entire body.

When this type of injury continues to cause symptomatic instability of the knee (buckling or giving way during physical activity) surgery to reconstruct the ligament is indicated. Unfortunately, once someone has suffered an ACL tear and their ligament strength has been compromised, they automatically assume a higher risk for a repeat of the same injury.

Though re-tearing of a repaired ACL is quite common among active athletes, recent studies have suggested that identification and patient education regarding modifiable risk factors may minimize the chance of a repeat ACL tear.

According to one study published in the American Orthopedic Society of Sports Medicine, female athletes under the age of 25 have the highest risk for a repeat tear of the ACL after initial surgical reconstruction. So what makes these young females specifically more susceptible to secondary injury than others? The most influential factor pinpointed in the study, was graft size. An ACL tear is unique in that it cannot simply be repaired by sewing the two torn ends back together. Instead it must be replaced by another piece of tissue. During the surgical repair of an ACL, a piece of healthy tissue (a graft) is borrowed from either the surrounding hamstring or patella tendons, and positioned over the injured ACL tissue.

The patients who received a smaller graft measuring less than 8 millimeters showed the increased risk of re-tearing the ACL in the future. In addition, estrogen levels, anatomical differences in structure, and decreased knee strength may also play a role in repeat injuries in some women. In order to combat these statistics, surgeons can now use this information to their advantage when consulting with patients pre-surgery, and may consider modifying their surgical plan to utilize larger grafts in their younger female patients, when indicated.

Aside from the surgical modifications that can be made to minimize the risk of re-injury, it is crucial for patients to take responsibility for correct and consistent physical rehabilitation strategies. Safely strengthening the muscles and tissues around the knee is a key element in preventing secondary ACL tears. The function of the muscles in the injured leg should be just as strong as the uninjured leg before returning to normal activity. This can be accomplished through a rehab program directed by a physical therapist to include flexibility and strengthening exercises, endurance activities, and coordination and agility training.

 Combined responsibility of the surgeon’s operative plan, and the patient’s dedication to post-operative rehab go hand-in-hand. With better education about adjustments that can be made based on the known risk factors, patients will be able to better minimize ACL re-tears, and resume and maintain healthy and active lifestyles.