ACL tears: symptoms, diagnosis and treatment


Anterior cruciate ligament (ACL) tear is a knee joint injury that often occurs during sports activities. This causes leg pain and knee instability. Cruciate ligament tears are common in eminent athletes such as soccer player Tom Brady, golfer Tiger Woods, and soccer player Frankie Hayduk. It is also one of the most common injuries among amateur athletes of all ages.

A torn ACL is diagnosed through a physical exam. You may need an imaging test, such as an x-ray, to determine if you have other injuries (such as a bone fracture).

Depending on the severity of the injury and the severity of your symptoms, you may need physical therapy , a brace, or surgery. Rehabilitation is often part of recovering from surgery.

Get Medication Information / Brianna Gilmartin


You may hear a sudden clicking sound and / or feel a sudden movement of the joint during an ACL injury. Most people are surprised at how loud the applause can be, and sometimes passersby can even hear it on the bookshelf at a soccer game.

Right after an ACL tear, you can quickly develop hemarthrosis (bleeding into a joint). It causes swelling , redness, warmth, bruising, pain, and a blistering sensation in the joint.

What to look for

The signs and symptoms of an ACL injury are not always the same, so it is important to see your doctor if you experience any of the following:

  • Knee pain or swelling that lasts more than 48 hours.
  • Problems standing or walking on the affected knee.
  • Inability to bear weight on the affected knee
  • A misshapen or odd appearance on one side of the knee.

If the anterior cruciate ligament tears, your joint will be unstable and will tend to collapse. This can happen when you play sports or even perform simple movements like walking or getting in your car.

Athletic performance after anterior cruciate ligament tear

Athletes often struggle after an ACL injury. Sports like soccer, football, and basketball rely on your ACL to perform common maneuvers like cutting, turning, and turning sharply.

For this reason, athletes often opt for surgery to return to their previous level of competition.


ACL tear is usually a sports-related injury. Cruciate ligament tears can also occur during horseplay, car collisions, falls, and work-related injuries.

Approximately 60-70% of ACL tears occur without contact with another athlete. It is common for the athlete to change direction abruptly (cuts or twists), which causes excessive stretching and rupture of the ligaments .


A ligament is a strong connective tissue ligament that connects bones to each other to provide stability.

The ACL is one of the four main ligaments in the knee. Together with the posterior cruciate ligament, the medial and lateral collateral ligaments, the ACL provides stability to the knee. The ACL is placed in front of the knee and, together with the posterior cruciate ligament, forms a cross shape on the lower surface of the femur and the upper surface of the leg to stabilize them.

When leg movements stretch or pull this ligament, it can tear. The size of the lesion varies from a small rupture of the fibers of the connective tissue to a complete rupture and detachment.

ACL tears in women

Female athletes are especially prone to anterior cruciate ligament tear. Research has shown that female athletes have an eight-fold increase in ACL tears compared to their male counterparts.

The reason for the increased risk has been debated for decades and experts now believe it is due to differences in neuromuscular control. Men and women position the knee differently during important athletic movements, such as landing, cutting, and turning. Differences in male and female anatomy and hormone levels can also contribute to different rates of ACL tear.


The diagnosis of ACL tear is based on several methods. Your healthcare provider will not only listen to your symptoms, but will also perform a physical exam and assess your mobility, strength, and swelling in your knees.

Your healthcare provider can evaluate your knee ligaments using special maneuvers that check the stability of your knee, including:

  • Lachman test: The Lachman test is performed to assess translational movement of the tibia (lower leg). By pulling the tibia forward, the doctor can palpate the torn anterior cruciate ligament (ACL). The knee is slightly bent (about 20-30 degrees), the thigh (femur) is stabilized, and the tibia is displaced.
  • Drawer test – The drawer test is performed when the knee is bent 90 degrees. Your tibia moves back and forth to assess your ACL by pulling forward, and your PCL is assessed by pushing back.
  • Pivot change maneuver: The pivot change is difficult to perform in the office and is usually most effective in the operating room under anesthesia. The hinge shift maneuver detects abnormal knee motion in the presence of an ACL tear.

The physical exam will also assess the strength of your leg and other important knee ligaments.

Visual tests

You may also need an X-ray of the knee, which can identify bone fractures. An magnetic resonance imaging (MRI) can also be used to determine if your ligament is torn, if your cartilage has been damaged, and to look for signs of other related knee injuries.

Keep in mind that while MRIs can help diagnose injuries to and around the knee, an MRI is not always required to diagnose an anterior cruciate ligament tear.

In addition to evaluating whether you have an ACL tear, your PCP's evaluation also looks at other injuries that may have occurred when you were injured.

ACL tear evaluation

ACL sprains are classified according to the degree of ligament damage .

  • A grade 1 sprain is a mild sprain and your knee is still fairly stable.
  • Level 2 is a partial ACL tear, the ligament of which is stretched so much that it becomes loose and damaged. This is relatively rare.
  • Meanwhile, with the most common grade 3 sprains, there is a complete rupture of the anterior cruciate ligament, with the knee becoming unstable, and surgery is almost inevitable if it needs to be corrected.

Watch out

Many people who have ruptured ACL begin to feel better within a few weeks after injury. Most people do not need surgery after an ACL tear, especially if the ACL is only partially torn. If you don't exercise and don't have an unstable knee, you may not need ACL surgery.

Conservative treatment

If you've had a partial ACL tear , conservative treatment may be helpful, which may include a combination of rest, pain relief, and treatment for edema. Eventually, you can begin physical therapy and / or wear a knee brace. Physical therapy for a partial ACL tear includes strengthening exercises, balance exercises, and range-of-motion exercises.

However, even if you are not in pain, you may still have persistent symptoms of knee instability. When deciding on an operation on the ACL , there are several important factors to consider. You should consider the frequency and severity of your symptoms, and whether you are preparing for surgery, as well as post-operative rehabilitation and healing.


A common operation for ACL tear is called ACL reconstruction. Ligament repair is usually not possible, so the ligament is repaired with a different tendon or ligament.
There are several different approaches to ACL surgery, and your healthcare provider will explain which one is best for you. For example, various types of grafts can be used to repair a torn anterior cruciate ligament. Your doctor can use one of your own ligaments or can use a donor graft. Using your own ligament generally results in stronger healing.

There are also variations in the procedure, such as a new "double bind" reconstruction of the ACL .
Risks of ACL surgery include infection , persistent instability, pain, stiffness , and difficulty returning to previous levels of activity.

ACL graft healing takes time

After the operation, it is important that the graft has time to heal, otherwise it may fail. This process can take several months.

The good news is that most people have no complications after ACL surgery.

Postoperative rehabilitation

Postoperative rehabilitation is one of the most important aspects of treatment. Exercise aims to restore movement and strength, and improve joint stability to prevent future injury.
You can learn to do some exercises on your own by moving forward at a steady pace.

Progressing too fast or too slow can have detrimental effects on the overall results of the operation, so it is important that you continue to work under the guidance of a therapist and doctor throughout the recovery period.


After surgery to repair your ACL, you may need a knee brace . These braces are designed to restrict range of motion, stabilize the knee, and ensure proper ACL recovery.

Not everyone needs a knee brace after surgery, and this decision is based on the amount of support your knee needs as it heals.

Children and surgery

The decision to undergo ACL surgery in children requires taking into account a number of factors that are not related to adults.
Surgery increases the risk of growth problems in children. ACL surgery can cause destruction of the growth plate, for example, early closure of the growth plate or distortion of the alignment .

Childhood ACL Surgery

You and your child's healthcare provider will have to weigh the risk of surgically causing growth plate problems with the risk of permanent knee injury if the ACL is not repaired.

Get the word of drug information

Prevention of anterior cruciate ligament (ACL) tears is very important. You may have a higher risk of rupture if you are an athlete or if you have already had an anterior cruciate ligament tear, even if it has been repaired with surgery.

Neuromuscular training can help improve muscle control and reduce the likelihood of this type of injury.

If you've had an injury, it's important to wait long enough before playing again. This can be difficult, especially for professional athletes and students with athletic scholarships. Experts recommend waiting six to 12 months after a serious ACL injury before returning to play. In the meantime, it is important to continue safe training so that your muscles remain strong and you do not experience atrophy .

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