Description
An anterior cruciate ligament (ACL) tear is a sprain (tear) of one of the four major ligaments of the knee. The ACL is a ropelike structure that helps maintain the normal relationship of the femur (thigh bone) and the tibia (leg bone). This ligament is most important in sports that require pivoting, changing direction (cutting), or jumping and landing. When torn, this ligament does not heal, although it may attach by scar tissue to other structures of the knee.
Common Signs and Symptoms
- Pop or tear heard or felt at the time of injury
- An inability to continue playing after the injury
- Large knee swelling noticed within 6 to 8 hours after the injury (often within 3 hours)
- Inability to straighten knee
- Knee giving way or buckling, particularly when trying to pivot, cut (rapidly change direction), or jump
- Swelling with repeated giving way
- Occasionally, locking when there is concurrent injury to the meniscus
Causes
- Force that exceeds the strength of the ligament
- May result from noncontact injury (landing awkwardly or cutting while cleats are stuck to the ground) or from contact such as getting tackled at the knee
- Sports that require pivoting, jumping, cutting, or changing direction (basketball, soccer, volleyball) or contact sports (football, rugby)
- Poor physical conditioning (strength and flexibility)
- Female gender (women appear to have higher risk than men)
- Improper equipment
- Appropriately warm up and stretch before practice and competition.
- Maintain appropriate conditioning:
- Thigh, leg, and knee flexibility
- Muscle strength and endurance
- Cardiovascular fitness
- Use proper technique (balance and jump training).
- Use proper equipment (appropriate length of cleats for surface).
The ACL does not heal on its own, but most people can perform normal daily activities after an appropriate rehabilitation program. For those who want to return to participating in sports that require pivoting, cutting, and jumping and landing, surgery is usually required.
Possible Problems Resulting from an ACL tear
- Frequent recurrence of symptoms, such as knee giving way, instability, and swelling
- Injury to meniscal cartilage, resulting in locking and swelling of the knee
- Injury to other structures of the knee, including the articular cartilage, resulting in arthritis of the knee
- Injury to other ligaments of the knee
- Knee stiffness (loss of knee motion)
Initial treatment consists of medications and ice to relieve pain and reduce the swelling of the knee. Walking with crutches until you walk without a limp is often recommended (ability to put full weight on the injured leg). Range-of-motion, stretching, and strengthening exercises may be carried out at home, although usually referral to a physical therapist or athletic trainer is recommended. Occasionally your physician may recommend a knee brace, especially if other ligaments are injured along with the ACL. For those patients who do not perform sports that require pivoting, cutting, and jumping and landing frequently, surgery may not be required and rehabilitation is recommended. Individuals who usually exercise by jogging, cycling, or swimming only may not require ACL surgery. Rehabilitation of ACL tears usually concentrates on reducing knee swelling, regaining knee range of motion, regaining muscle control and strength, functional training, bracing (occasionally), and education, such as avoiding sports that require pivoting, cutting, changing direction, and jumping and landing. For those who do perform sports that require pivoting, cutting, and jumping and landing frequently, surgery is recommended to allow return to these sports.
Medication
- Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.
- Stronger pain relievers may be prescribed as necessary by your physician. Use only as directed and only as much as you need.
- Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to15 minutes every 2 to 3 hours for inflammation and pain, and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage. Cold compression may be helpful.
- Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or trainer. Use a warm compress, or a topical cream (like Icy-Hot or Ben-Gay)
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