ACL FAQ

The ACL is one of four strong fibrous tissue bands called ligaments that hold together and support the knee. Your ACL stabilizes your knee while you play sports, run errands, or go for a walk. The ACL runs diagonally inside your knee between your thigh (femur) and shin (tibia) bones. Your ACL primarily keeps your knee stable when you turn, cut, twist and pivot. Unfortunately, it is the knee ligament most often injured. An ACL tear is one of the most common and devastating sports injuries.

ACL injuries are common and can occur by pivoting quickly, landing awkwardly, or stopping suddenly.

The three grades of ACL injury range from mild to severe.
1. Sprain Trauma to the ligament is relatively minor. Some of the fibers are stretched.
2. Grade II – Partial Tear Trauma to the ligament is more severe. Some of the fibers are torn.
3. Grade III – Complete Tear This is the most severe ACL injury. The fibers of the ligament are
completely torn.

If you feel a popping sensation in your knee, experience swelling, have no range of motion, and/or are in severe pain, you may have an ACL injury.

Injuries to the ACL can occur in several ways, usually without contact. High speed twists, bending or extending the knee beyond its normal range, or landing “wrong” from a jump may result in an ACL tear. Basketball, volleyball, tennis and soccer players, as well as skiers and snowboarders are particularly vulnerable. More than 90 percent of the time, it tears completely.

When your ACL tears:

• Seventy percent of those suffering an ACL tear feel or hear a pop.
• You’ll feel pain that increases when you bend your knee or try to walk. It may hurt to put any weight on that leg.
• Usually your knee will swell quickly.
• Your leg might feel unstable. This is because your shin can move forward beyond its natural range (called loss of anterior stability). Also swelling and pain in your quadriceps (front of thigh) may keep the muscle from working properly.
• Your range of motion might be severely limited. It will be painful to straighten your leg.

ACL tears can be confirmed only through medical evaluation or magnetic resonance imaging (MRI). If you experience symptoms of a torn ACL, you should get a medical professional’s diagnosis as soon as possible to begin your recovery. If your ACL is torn, you’ll be referred to an ACL professional specializing in knee injuries.

• The knee is the largest joint in the body. It works in coordination with every other muscle and bone on that side of your lower body up through your back. The knee’s ability to support all activities, especially demanding sports, is astonishing. A knee injury is a big disruption to your body.
• The ACL is critical to stabilizing your knee.
• Very little blood circulates inside your knee, which slows healing.
• ACL surgery rehabilitation develops functionality and strength. Functionality is being able to do something. Strength is being able to do it with force. Strength takes longer to regain than functionality.

Yes. Even the best reconstruction surgery cannot eliminate the possibility of a re-tear.

Yes. Studies have shown females are two to seven times more likely to tear an ACL than males competing in the same sports. Theories for this difference between sexes range from hormonal and anatomical differences to lower biomechanic and neuromuscular control.

Rehab can start straight after ACL injury. It follows the same principles as rehab after surgery, except you can usually progress at a faster rate because you don’t need to account for the postoperative pain, swelling and difficulty contracting your muscles that occurs with surgery.

Just like rehab after surgery, a physiotherapist will set goals with you and give you exercises to work on strength, balance and movement. The key aspect of rehab is completing these exercises at home or in the gym at least two – three times a week for 12 months or less.

An ACL physiotherapist can let you know if you’re ready to return to running, jumping, pivoting, and competitive sports. Of those who return to sport, most do so 12 – 18 months after surgery, but everyone’s recovery is different.

An ACL reconstruction is a surgical procedure that involves removing the remains of the damaged ACL and replacing it with another form of soft tissue, called a graft. The graft is either autogenous, which comes from the patient, or an allograft, which is tissue donated by an individual at the time of death.

What does ACL surgery involve?
An ACL reconstruction is performed under a general anaesthetic. Incisions are made at the front of the knee with a surgical blade to allow access to the knee joint. The surgeon will insert a small camera, probe, drill, screwdriver and other tools through the incision to perform the procedure. The surgeon will remove the torn ACL from the bone, and drill tunnels into the thigh bone (femur) and shin bone (tibia). The ACL graft is placed into the tunnels and held in place by screws. The screws will secure the ACL graft (tissue taken from elsewhere in the body to replace the ACL) to the thigh and shin bones.

You will most likely spend the night in hospital.

Surgery is not required for all ACL injuries. Partial tears, in which a physical examination shows a relatively stable knee, may be treated with bracing and rehabilitation. Even some patients with complete ACL tears do not need reconstruction. These “copers” are typically older patients with lower physical activity, who do not participate in pivoting and cutting activities.While some patients may respond to nonsurgical treatment, most young people with an ACL injury will need surgery. Factors such as age, activity level, and the severity of the injury will determine treatment.

One reason to reconstruct the ACL is to provide knee stability that allows for return to activities and sports. Another reason is to provide knee stability in order to prevent more injury, such as a meniscal tear, which may eventually lead to degenerative joint disease.

The anterior cruciate ligament provides stability to the knee particularly with twisting, turning and change of direction activities.  Immediately after an ACL tear, your knee will be sore but the pain will settle provided there are no other injuries. The end result of the cruciate ligament tear is an unstable knee, not a painful knee. Most people with an anterior cruciate ligament tear are unable to return to competitive sporting activities without reconstruction. Straight line activities such as walking, swimming and cycling are still possible. Cruciate ligament reconstruction surgery is undertaken to restore stability to the knee joint to improve quality of life and allow sporting activities. It is also generally accepted that an unstable knee with a torn cruciate ligament is more likely to develop arthritis in the longer term. The risk of arthritis after an ACL tear is increased but that does not mean that it occurs in all patients.

Your doctor will determine the best treatment for you based on the tear location and other factors. Your surgeon will likely perform an ACL reconstruction, which removes the damaged ligament and replaces it with a graft.

There are additional procedures that your doctor may decide to perform to support your ACL repair or reconstruction. Extra-articular augmentation, which can reduce the risk of reinjury after ACL surgery.
To help with rotational stability and to minimize the risk of reinjuring your ACL, additional procedures to support other parts of your knee —like anterolateral ligament (ALL) reconstruction or iliotibial band (ITB) tenodesis— may be included in your repair or reconstruction. Clinical studies show that combining these types of procedures with an ACL repair or reconstruction may help improve patient results.

Immediately after ACL surgery, your knee will be bandaged and may be swollen. When the bandage is removed, you will see incisions with stitches. The number of stitches and size of incisions depends in the case of reconstruction, which graft was used to reconstruct your ligament. Generally, the small incisions heal within a few weeks, and you may have small scars.

Rehab starts straight after surgery. Physical therapy is necessary after an ACL reconstruction procedure to properly strengthen and recover the knee. Rehabilitation varies for each patient. Find your ACL Professional.

At first, the rehab will focus on reducing swelling, getting the knee moving again and working to switch on the muscles around your knee.

As the pain and swelling in the knee improves, a physiotherapist will set goals with you and give you exercises to work on strength, balance and movement. The key aspect of rehab is completing these exercises at home or in the gym at least two – three times a week for around 12 months.

A physiotherapist can let you know if you’re ready to return to running, jumping, pivoting, and competitive sports. Of those who return to sport, most do so 12 – 18 months after surgery, but everyone’s recovery is different.

When you can safely drive a car will depend on several factors, including which knee (left or right) was injured, your range of motion to safely operate the gas and brake pedals, and when you stop taking prescription pain medication.

Several factors determine when you can return to work, including your profession, your work environment, and how you feel after your procedure. Your ACL Professional will recommend a timeline specific to your needs and recovery process.

Several factors impact when you will return to sports or activities, and not every patient will return at the same time. Also not every patient return to his sports. After ACL reconstruction, it could take as long as a year or more before a patient can safely return to sports and activities. A longer recovery period may reduce the risk of reinjury.