Table of ContentsView AllTable of ContentsWhat Are ACL Tears?SymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What Are ACL Tears?
Symptoms
Causes
Diagnosis
Treatment
An anteriorcruciateligament (ACL) tear is a knee joint injury that usually occurs while playing sports. It causes leg pain and instability of the knee. This is one of the most common injuries among recreational athletes of all ages.
A physical examination diagnoses an ACL tear. However, an imaging study, such as an X-ray, may be needed to determine whether you also have other injuries (like a bone fracture).
Depending on the extent of your injury and the severity of your symptoms, you may need treatment withphysical therapy, a supportive brace, or surgery. Often, rehabilitation is part of recovery after surgical treatment.
This article will discuss the symptoms and causes of ACL tears along with diagnosis and treatment.
Verywell / Brianna Gilmartin
A ligament is a strong band of connective tissue that attaches bones, providing stability.
TheACLis one of four major knee ligaments. Along with the posterior cruciate ligament and the medial and lateral collateral ligaments, it helps provide stability for your knee. The ACL is located in front of your knee, and, along with your posterior cruciate ligament, it forms a crisscross shape across the lower surface of yourthigh boneand the upper surface of your shin bone to stabilize them.
It can rip when your leg movements stretch or pull this ligament. The size of the injury varies from a slight tear of connective tissue fibers to a complete tear and detachment.
Symptoms of ACL Tears
Right after an ACL tear, you can rapidly develophemarthrosis(bleeding into your joint). This causes:
With an ACL tear, yourjoint will be unstableand prone to give out. This can occur when you are participating insportsor even with simple movements like walking or getting into a car.
The signs and symptoms of an ACL injury are not always the same, so it is important to see a healthcare provider if you experience any of the following:
Sports Ability After an ACL Tear
Athletes often have difficulty after experiencing an ACL injury. Soccer, football, and basketball rely on your ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.
For this reason, athletes often undergo surgery to return to their previous level of competition.
Causes of ACL Tears
An ACL tear is most often a sports-related injury, but it can also occur during rough play, motor vehicle collisions, falls, and work-related injuries.
About 60% to 70% of ACL tears occur without contact with another athlete. Typically, an athlete suddenly changes direction (cutting or pivoting), which causes excessive stretching and tearing of the ligament.
Anatomy of the Knee
ACL Tears in Women
Female athletes are especially prone to ACL tears. Research has shown up to an eight-fold increase in the number of ACL tears in female athletes compared with their male counterparts.
The reason for the increased risk has been debated for decades, and experts now believe that differences in neuromuscular control cause it. Men and women position the knee differently during critical sports movements such as landing, cutting, and pivoting. The differences in male and female anatomy and hormone levels may also factor into the different rates of ACL tears.
Diagnosing ACL Tears
The diagnosis of an ACL tear relies on several methods. Along with listening to your symptoms, your healthcare provider will perform a physical examination and assess your knee mobility, strength, and swelling.
Your healthcare provider can evaluate the ligaments of your knee with specialized maneuvers that test the stability of your knee, including:
Your leg strength and other major knee ligaments will also be assessed during your physical examination.
Imaging Tests
You may also need an X-ray of your knee, which can identify bone fractures. Amagnetic resonance imaging (MRI) studymay also determine whether your ligament is torn, whether you have sustained damage to your cartilage, and look for signs of other associated injuries in the knee.
Remember that while MRI studies can help diagnose injuries in and around your knee, an MRI is not always needed to diagnose an ACL tear.
Along with evaluating you for an ACL tear, your healthcare provider’s assessment is also focused on identifying other injuries that may have occurred when you had your injury.
Grading ACL Tears
ACL sprains are graded based on how much the ligament is damaged.
Treatment of ACL Tears
Can an ACL tear heal without surgery?Many people who experience an ACL tear start tofeel better within a few weeksof the injury. Most people do not need surgery after an ACL tear, especially if the ACL is only partially torn. If you don’t play sports, and if you don’t have an unstable knee, then you may not need ACL surgery.
Can an ACL tear heal without surgery?
Many people who experience an ACL tear start tofeel better within a few weeksof the injury. Most people do not need surgery after an ACL tear, especially if the ACL is only partially torn. If you don’t play sports, and if you don’t have an unstable knee, then you may not need ACL surgery.
Conservative Management
If you have apartial ACL tear, you may benefit from conservative management, which can include a combination of rest, pain control, and management of the swelling. Eventually, you can start physical therapy and/or use a knee brace. Physical therapy for a partial ACL tear includes strengthening, balance, and range of motion exercises.
Nevertheless, even if you don’t experience any pain, you might continue to have persistent symptoms of knee instability. Several important factors need to be consideredwhen deciding on ACL surgery. You need to consider the frequency and severity of your symptoms and whether you are prepared to undergo surgery, postoperative rehabilitation, and healing.
Surgery
The usual surgery for an ACL tear is called an ACL reconstruction. Since a repair of the ligament is not usually possible, it is reconstructed using another tendon or ligament.
There are severalapproaches to ACL surgery, and your healthcare provider will explain which is best for you. For example, severaltypes of grafts can be usedto reconstruct the torn ACL. Your practitioner can use one of your ligaments, or you can use a donor graft. Typically, using your ligament results in more potent healing.
The procedure also has variations, such as the new “double-bundle” ACL reconstruction.Risks of ACL surgery includeinfection, persistent instability, pain,stiffness, and difficulty returning to your previous level of activity.
Healing of an ACL Graft Takes TimeAfter surgery, it is important that the graft has time to heal or else it can fail. This process can take months.
Healing of an ACL Graft Takes Time
After surgery, it is important that the graft has time to heal or else it can fail. This process can take months.
The good news is that most people do not have any complications after ACL surgery.
Post-Surgical Rehabilitation
Post-surgical rehabilitationis one of the most important aspects of healing.Exercisesfocus on restoring motion and strength and improving joint stability to prevent future injuries.You can learn to do someexercises on your ownwhile advancing at a steady pace.
Progressing too quickly or too slowly can be detrimental to your overall results from surgery, so you must continue to work under the guidance of your therapist and your healthcare provider throughout your recovery.
Braces
You may need to use aknee braceafter ACL reconstruction surgery. Thesebracesare designed to limit your range of motion, help stabilize your knee, and allow your ACL to heal properly.
Not everyone needs a knee brace after surgery; this decision is based on how much support your knee needs while healing.
Kids & Surgery
The decision about ACL surgery for childrenrequires consideration of several factors that are not relevant to adults. Surgery increases the risk of growth problems in children. ACL surgery can cause growth plate disruptions, such as early growth plate closure or alignment deformities.
Childhood ACL SurgeryYou and your child’s healthcare provider will have to weight the risk of surgically induced growth plate problems with the risk of permanent knee damage if the ACL is not fixed.
Childhood ACL Surgery
You and your child’s healthcare provider will have to weight the risk of surgically induced growth plate problems with the risk of permanent knee damage if the ACL is not fixed.
Summary
Preventing ACL tears is essential. You may be at a higher risk of having one if you are an athlete or if you have had one before, even if it was surgically repaired.
Neuromuscular training may help improve muscle control and reduce the chances of sustaining these types of injuries.
If you have had an injury, you must wait long enough to heal before you return to playing. This can be difficult, especially for professional athletes and students with athletic scholarships. Experts recommend waiting six to 12 months after a significant ACL injury before returning to play. In the meantime, it is essential to continue safely training so your muscles will stay strong and not experiencemuscle atrophy.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Raines BT, Naclerio E, Sherman SL.Management of anterior cruciate ligament injury: What’s in and what’s out?Indian J Orthop. 2017;51(5):563–575. doi:10.4103/ortho.IJOrtho_245_17Sokal PA, Norris R, Maddox TW, Oldershaw RA.The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3287-3303. doi:10.1007/s00167-022-06898-4Zhao GL, Lyu JY, Liu CQ, Wu JG, Xia J, Huang GY.A modified anterior drawer test for anterior cruciate ligament ruptures.J Orthop Surg Res. 2021;16(1):260. doi:10.1186/s13018-021-02381-xFerretti A, Monaco E, Fabbri M, Maestri B, De Carli A.Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears.Arthroscopy. 2017;33(1):147-154. doi:10.1016/j.arthro.2016.05.010Dingel A, Aoyama J, Ganley T, Shea K.Pediatric ACL tears: natural history.J Pediatr Orthop. 2019;39(6, Suppl 1):S47-S49. doi:10.1097/BPO.0000000000001367
Raines BT, Naclerio E, Sherman SL.Management of anterior cruciate ligament injury: What’s in and what’s out?Indian J Orthop. 2017;51(5):563–575. doi:10.4103/ortho.IJOrtho_245_17
Sokal PA, Norris R, Maddox TW, Oldershaw RA.The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3287-3303. doi:10.1007/s00167-022-06898-4
Zhao GL, Lyu JY, Liu CQ, Wu JG, Xia J, Huang GY.A modified anterior drawer test for anterior cruciate ligament ruptures.J Orthop Surg Res. 2021;16(1):260. doi:10.1186/s13018-021-02381-x
Ferretti A, Monaco E, Fabbri M, Maestri B, De Carli A.Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears.Arthroscopy. 2017;33(1):147-154. doi:10.1016/j.arthro.2016.05.010
Dingel A, Aoyama J, Ganley T, Shea K.Pediatric ACL tears: natural history.J Pediatr Orthop. 2019;39(6, Suppl 1):S47-S49. doi:10.1097/BPO.0000000000001367
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