Whether you’re an athlete who plays volleyball, basketball, football, skiing or other sports, you’re someone with an active lifestyle, or you engage in physical activity, you can be at risk for an anterior cruciate ligament (ACL) tear.
When this happens, you will need either surgical or nonsurgical treatment. However, you might wonder what an ACL tear is, where it happens, what triggers it, and how you can seek treatment. Read on to find out more about ACL tears and treatment options.
What is an ACL Tear?
An ACL tear damages the anterior cruciate ligament found at the knee’s center. You may experience a partial tear, where the ligament is torn slightly, or more commonly a complete tear, where the ligament is completely torn into two. When you tear your ACL, you may hear and feel a popping sound, your knee will likely buckle, and it will be painful. Your knee may experience swelling as well.
About half of the ACL injuries involve damage to the articular cartilage, meniscus, and other ligaments. ACL injuries are also divided into three grades:
- Grade 1: For grade 1 injuries, the ACL only has mild damage. It may be slightly stretched, but it can still help maintain the stability of your knee joint.
- Grade 2: A grade 2 sprain or a partial tear of the ligament is when the ACL is stretched and partially torn. The ligament gets loose and cannot perform its function of holding the knee joint in place. However, partial tears rarely occur.
- Grade 3: Grade 3 sprains or complete tears of the ligament occur when the ligament is torn in half. The ACL can no longer keep the knee joint stable. Among the three classifications, complete ACL tears are also the most common.
Where Does This Occur?
As its name suggests, an ACL tear occurs in the anterior cruciate ligament in your knee’s front center. The ACL belongs to the tissue bands connecting your thigh bone (femur) and shin bone (tibia). Four important ligaments, namely connect these two bones:
- Medial collateral ligament (MCL): Running along the inside of your knee, your MCL helps prevent it from bending inward.
- Lateral collateral ligament (LCL): Running along the outside of your knee, the LCL keeps your knee from bending outward.
- An anterior cruciate ligament (ACL): Located in the middle of your knee, the ACL helps keep your shin bone from sliding out in front of your thigh bone.
- A posterior cruciate ligament (PCL): Along with the ACL, your PCL helps prevent your shin bone or tibia from sliding backward under your femur.
Why Does an ACL Tear Happen?
An ACL injury or tear is usually a non-contact injury. For example, it does not occur because another player kicks your knee. Instead, ACL injuries typically happen due to missteps or other cutting injury. For instance, you could be running, quickly change directions, and end up twisting your knee. An ACL injury could also occur when you slow down while running or promptly stop running, putting extreme stress on your knee ligaments.
Other cases where an ACL injury happens include landing awkwardly from a jump, falling or landing on one foot, colliding with someone during a football tackle, and twisting your legs and knees. ACL injuries are common in sports that require sudden stops, jumps, and changes in direction, such as football, basketball, downhill skiing, and soccer.
Moreover, ACL injuries usually come with injuries to other knee ligaments. These include the medial collateral ligament and medial meniscus, which also helps stabilize your knee.
Anterior Cruciate Ligament Tears’ Signs and Symptoms
When you experience a partial or complete ACL tear, you might feel a popping sensation in your knee or feel your knee giving out. Among other common symptoms are:
- Swelling: This happens immediately or within four to six hours after the ACL injury. Put some ice on your knee, and then elevate your leg with the help of a pillow to manage the swelling.
- Pain: You will feel pain in your knee’s joint line. You may also have difficulty standing or applying pressure on the affected leg. However, note that minor injuries may not be painful.
- Loss of range of motion: When your ACL is damaged, you might not be able to flex or bend your knee as usual.
- Difficulty walking: In some cases, you may be able to apply pressure to your affected leg, but it will still be more difficult to walk than normal. Some may observe that their knee joints feel more loose than usual.
Seek Treatment and Support
Your treatment options for an ACL injury or tear are based on several factors. These include your symptoms, type of injury, physical exam results, activity goals, and growth remaining in your growth plates. The physical exam involves checking each structure of your injured knee and comparing it to the non-injured one.
The doctor may also perform X-rays to determine whether the injury is related to a broken bone. In addition, you will likely need an MRI scan to confirm the diagnosis and to find other injuries in the knee’s soft tissue structures, like the meniscus and cartilage. Your healthcare provider may recommend nonsurgical or surgical treatments based on these multiple factors and test results.
Nonsurgical treatments aim to keep the strength of the muscles surrounding the joint and maximize the joint’s stability. One option is bracing, which can help protect your knee against instability. Patients who wish to return to athletic activity can wear a custom sports brace.
You may also have to undergo physical therapy. You can enhance your range of motion in the injured knee through rehabilitation exercises. At the same time, you can strengthen the leg muscles supporting the joint.
Nonsurgical treatments are often advised for individuals that have:
- Partial ACL tears with no instability symptoms
- Complete tears without knee instability symptoms
These treatments are also usually for individuals who play low-demand sports, do only light physical labor, or have a sedentary lifestyle.
A torn ACL is generally replaced by a tendon called a graft. It could be an autograft, which means using a tendon from your knee is used to reconstruct the ACL. Examples include the hamstring tendon, which is from the back of your thigh, and the patellar tendon, which is from the front of your knee. ACL reconstruction surgery may also involve an allograft, which uses a human donor (cadaver) tendon.
Individuals who should consider surgical reconstruction include those who play sports, live an active lifestyle, perform heavy manual work, or perform jobs that involve a lot of turning, intricate cutting, or changing directions quickly. Early ACL reconstruction may result in growth plate injury for adolescents or young children with ACL tears.
However, recent research supports early ACL reconstruction because delayed treatment may increase the risk of future cartilage or meniscus injuries. Moreover, newer surgical techniques made surgical reconstruction possible for children and teens. Individuals with combined injuries in the ACL and menisci may also need surgical treatment.
This surgical treatment is also minimally invasive. Thus, the orthopedic surgeon will not make large incisions but instead use an arthroscope. It’s a thin instrument inserted into your joint through minor cuts. This way, the surgeon can see the extent of damage in the joint using a small camera (arthroscope).
What’s Next After ACL Injury Surgery?
Once your outpatient ACL surgery is over, it’s essential to keep the wound clean and dry. To manage pain and swelling, apply ice to your knee regularly. You might need to use crutches and a brace. Then, to keep strengthening your knee and the surrounding muscles, you’ll undergo physical therapy.
A few days after the surgery, do slow and simple strengthening exercises. You can also perform some weight-bearing exercises. You can engage in sport-specific activities around 12 to 16 weeks after the surgery if you are not an athlete. These include agility drills, jumping, hopping, and more. Your doctor will update you throughout your healing process. Meanwhile, athletes can return to regular activity for around six to nine months following their ACL surgery.
Contact Academy Orthopedics
Anterior cruciate ligament injuries are painful, can hamper your daily activity, and even negatively affect your career. While nonsurgical options work for some, most may require ACL reconstruction.
At Academy Orthopedics, we treat every patient like family and want to help you get back to your happy and active lifestyle as soon as possible. From knee arthroscopy and joint replacement surgery to sports medicine, our board-certified, fellowship-trained orthopedic surgeons are equipped to address your needs. Call us today at (770) 271-9857 for appointments and more information.