An ACL injury is a tear or sprain of the anterior cruciate (KROO-she-ate) ligament (ACL) — one of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia). ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing — such as soccer, basketball, football and downhill skiing.
Many people hear a pop or feel a "popping" sensation in the knee when an ACL injury occurs. Your knee may swell, feel unstable and become too painful to bear weight.
Depending on the severity of your ACL injury, treatment may include rest and rehabilitation exercises to help you regain strength and stability, or surgery to replace the torn ligament followed by rehabilitation. A proper training program may help reduce the risk of an ACL injury.
Signs and symptoms of an ACL injury usually include:
Seek immediate care if any injury to your knee causes signs or symptoms of an ACL injury. The knee joint is a complex structure of bones, ligaments, tendons and other tissues that work together. It's important to get a prompt and accurate diagnosis to determine the severity of the injury and get proper treatment.
Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone to your shinbone and helps stabilize your knee joint.
ACL injuries often happen during sports and fitness activities that can put stress on the knee:
When the ligament is damaged, there is usually a partial or complete tear of the tissue. A mild injury may stretch the ligament but leave it intact.
There are a number of factors that increase your risk of an ACL injury, including:
People who experience an ACL injury have a higher risk of developing osteoarthritis in the knee. Arthritis may occur even if you have surgery to reconstruct the ligament.
Multiple factors likely influence the risk of arthritis, such as the severity of the original injury, the presence of related injuries in the knee joint or the level of activity after treatment.
Proper training and exercise can help reduce the risk of ACL injury. A sports medicine physician, physical therapist, athletic trainer or other specialist in sports medicine can provide assessment, instruction and feedback that can help you reduce risks.
Programs to reduce ACL injury include:
Training to strengthen muscles of the legs, hips and core — as well as training to improve jumping and landing techniques and to prevent inward movement of the knee — may help to reduce the higher ACL injury risk in female athletes.
Wear footwear and padding that is appropriate for your sport to help prevent injury. If you downhill ski, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release appropriately if you fall.
Wearing a knee brace doesn't appear to prevent ACL injury or reduce the risk of recurring injury after surgery.
During the physical exam, your doctor will check your knee for swelling and tenderness — comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint.
Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include:
Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. Follow the R.I.C.E. model of self-care at home:
Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. A physical therapist will teach you exercises that you will perform either with continued supervision or at home. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee.
The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.
Your doctor may recommend surgery if:
During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon — tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft.
Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor.
After surgery you'll resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee.
There's no set time frame for athletes to return to play. Recent research indicates that up to one-third of athletes sustain another tear in the same or opposite knee within two years. A longer recovery period may reduce the risk of re-injury.
In general, it takes as long as a year or more before athletes can safely return to play. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk of ACL injury.
The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. Others may make an appointment with their family doctors. Depending on the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon).
Before an appointment, be prepared to answer the following questions:
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