Is Your Old ACL Injury Causing Pain and Dysfunction?

Physically active people can have a plethora of injuries over the course of a lifetime, and as much as they hurt at the time, many injuries are forgotten, once the pain subsides and function returns. ACL injuries and tears are especially common for young athletes, dancers and fitness lovers, and even with reconstructive surgery and rehab, they can come back to haunt you, years down the road.

Because of the knee joint’s location and function in the body’s lower kinetic chain, a knee injury can affect joints above and below. A knee that is not fully rehabbed after injury, or that deteriorates over time, can alter the way body weight is distributed over the ankle and foot, causing misalignment that leads to ankle instability, which in turn affects gait and balance, and increases injury risk during physical activity.

In the same way, a dysfunctional knee can translate upward, affecting the hip and misaligning the spine. This can lead to hip pain and instability, groin pain, pelvic instability and back pain. While many people write these issues off as the consequences of aging, they are in reality a consequence of injury.

The good news is that physical therapy can help improve knee function, even years after an injury, and dramatically reduce pain, dysfunction and instability throughout the body.

New research about the long-term consequences of knee injury is shedding light on the extent of the initial damage done to the tissues surrounding the knee, and how immediate treatment affects long-term outcomes.

• A study by Hettrich et al. (2013) evaluated 1,000 people, with a median age of 23 at the time of injury, for six years post-ACL reconstruction. Six years later, 9 percent had required at least one additional surgery on the same knee, and 10 percent needed surgery on the other knee, Of those, 6.4 percent were for ACL injury. The research team concluded that patients who had ACL surgery in their youth were more likely to need additional surgery later on.
• A 2012 study by Potter et al. ran MRIs for 11 years on 40 patients, with a total of 42 earlier ACL ruptures. Fourteen of the patients had rehabbed their knee without surgery, and 28 had undergone reconstructive surgery. The MRIs revealed that ACL tears had affected the surrounding cartilage, which had deteriorated over time, with cartilage loss in the lower femur up to 50 times greater than baseline. Cartilage loss to the knee cap itself was 30 times greater than baseline. The researchers concluded that progressive cartilage damage occurred to areas surrounding the knee that were not impacted by the initial ACL injury.

• A more recent study by Lohmander et al. (2020) surveyed patients with old ACL and meniscus injuries,10 to 20 years afterward. They found that 50 percent of the study participants had developed knee osteoarthritis that caused pain and dysfunction, and that knee injury survivors make up a substantial percent of the osteoarthritis population.
• In a final study (Lepley et al., 2020), researchers documented brain changes in patients who had undergone ACL reconstruction, and noted that those changes impacted performance and the risk of reinjury. The study involved MRI brain scans of 10 post-reconstruction patients, and discovered that the portion of the corticospinal tract that controlled the injured knee was 15 percent smaller than that on the uninjured side. They concluded that changes to the brain after ACL reconstruction can negatively impact the recovery of motor function.

If you have an old ACL rupture or knee injury from younger, more active years, having a thorough gait and biomechanical analysis now could help prevent future problems.

At NYDNRehab, we go beyond treating the knee and its surrounding structures after an ACL injury. We take rehab to the next level by reestablishing the relationship between the muscles and the brain, to ensure fully restored function.

• Diagnostic ultrasonography to identify changes in the structures surrounding the knee and monitor treatment results
• Top-of-the-line 3D gait analysis system to identify gait anomalies and retrain correct gait mechanics
• Zebris instrumented treadmill to measure ground reaction forces and pressure, and compare them on both sides of the body
• C.A.R.E.N (computer assisted rehab environment) system to analyze kinematic joint angle data and dynamic stability, and to provide virtual reality feedback training to restore knee function
• Surface EMG to analyze muscle firing patterns and identify compensation mechanisms and correct them

The team at NYDNRehab has rehabilitated over 100 patients with torn ACLs over the past six years. All had ACL tear treatment without surgery using our meticulous approach and advanced modern technology. Our results closely reflect those of various research studies. Only 20 of our patients were unable to return to sports, and subsequently went for surgical ACL repair.

At NYDNRehab, we go beyond treating symptoms of pain and dysfunction. Our advanced technologies and innovative treatment methods enable us to identify the underlying causes, collect baseline data, and develop rehabilitation protocols that restore neuromuscular and neurocognitive function. Our end goal is to eliminate pain and dysfunction, so our patients can enjoy the very best quality of life.