An Evolution in ACL Treatment

Adapted from the Fall 2012 issue of Discovery to Recovery

Anterior cruciate ligament (ACL) injuries are one of the most frequent injuries in many sports, including football, soccer, and basketball. The ACL is part of a complicated network of tendons and ligaments that help stabilize and support the knee.

Orthopedic surgeons at HSS have made significant contributions to the understanding, prevention, and treatment of ACL injuries. “In the 1960s and 1970s, ACL injuries were often missed diagnostically, treated relatively poorly, or not treated at all,” says Surgeon-in-Chief Emeritus Russell F. Warren, MD, who has been the New York Giants team physician for the past 30 years. “Physicians didn’t know enough about the ligament. In fact, there was an ongoing debate as to whether the ACL played a significant role in the knee and whether to fix it at all.”

Today, thanks to increased knowledge, more accurate examinations, and advanced imaging technology, physicians can diagnose ACL injuries earlier and more accurately.


While an ACL injury once may have ended an athlete’s career, today doctors are able to successfully manage and treat the injury to allow most players to return to sports. Early methods of surgery involved repairing the ligament or using a synthetic material to replace the ligament, but the failure rate was very high. Today, the most common corrective procedure for this injury is ACL reconstruction, which involves replacing the entire ligament with a tendon graft.

“There’s been an evolution in the way the ligament is reconstructed,” says Scott A. Rodeo, MD, co-chief emeritus of the Sports Medicine Institute at HSS and associate team physician for the New York Giants. “Today, the results of ACL surgery are good, and we can reproduce knee stability so that patients can get back to high level sports,” he explains. “Moving forward, one of the biggest challenges is to understand why, despite successful ACL surgery, many patients develop arthritis in the knee years down the road. The next frontier for physician scientists is to identify how we can prevent those late regenerative changes,” says Dr. Rodeo.


Rehabilitation after ACL surgery has also undergone a dramatic shift in the last three decades, and is still evolving as more information emerges about the ideal amount of motion following surgery. In the 1970s, athletes were required to wear a cast and not move their leg for six weeks following ACL surgery. When the cast was removed, the knee joint was very weak and stiff. “We now know that a knee that lacks motion has a greater propensity to get arthritis,” explains Dr. Warren, “so achieving motion right away is important to try to prevent that.”

In more recent years, physicians have also begun to understand how mechanical load on the knee (i.e., how much weight you put on it) affects graft healing. “For many years the push was for more and more aggressive rehabilitation,” explains Dr. Rodeo. “However, today we’ve learned that excess motion may actually impair early graft healing. As a result, rehabilitation for ACL continues to evolve to ensure proper healing.”

For the tens of thousands of people in the United States who may tear their ACL this year, their prognosis is positive for returning to an active lifestyle.

Read the full Discovery to Recovery Fall 2012 issue.



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