June 20, 2017
Whether you’re an athlete or just a sports fan, you’ve probably heard of the dreaded ACL tear. Though they’re most common in competitive athletes, anyone who is active is at risk for a torn ACL—and they’re devastating. While many injuries can heal on their own with rest, ACL tears cannot. If you leave an ACL tear untreated, the knee will remain painful and unstable. Over time, your torn ACL can even contribute to osteoarthritis, a painful condition where the cartilage between bones deteriorates and the bones begin to rub against each other. Needless to say, early detection is crucial. Here is information that will help you identify the signs of an ACL injury and the treatment options available.
Anterior Cruciate Ligament (ACL) Injuries
The anterior cruciate ligament (ACL) is one of the four main ligaments of the knee. Along with the posterior cruciate ligament, medial collateral ligament, and the lateral collateral ligament, the ACL connects the thighbone to the shinbone. And, despite being the smallest of these ligaments, it serves the most important role: stabilizing the knee for rotational movement.
The ACL provides approximately 90% of the stability in the knee joint. Without a healthy ACL, the knee may not always withstand the amount of weight on it and can give out without warning.
Types of ACL Injuries
An ACL injury occurs when it stretches past its limits. These injuries are classified into three grades based on severity.
Grade I (Stretched Ligament)
- The ligament is stretched but not torn.
- The knee exhibits little tenderness and swelling.
- The knee is also able to bear weight and does not give out during activity.
Grade II (Partially Torn Ligament)
- The ligament is partially torn.
- The knee exhibits little tenderness and moderate swelling.
- The knee feels unstable and gives out during activity.
Grade III (Completely Torn Ligament)
- The ligament is completely torn into two parts.
- The knee exhibits tenderness and swelling, with the former ranging from mild to severe.
- The knee feels unstable and gives out during activity.
Rapid changes in direction—such as cutting, pivoting, sidestepping—as well as incorrect landings put an enormous amount of stress on the knee. This, of course, means that ACL injuries are most likely to occur in sports that require dynamic movements at varying speeds. In fact, of the 70,000 to 80,000 ACL tears each year, the majority of them occur during soccer, basketball, football, and tennis. ACL injuries are less common in straightforward sports such as jogging and swimming and significantly less common in non-athletes.
The Signs and Symptoms of a Torn ACL
Without a doubt, a completely torn ACL is one of the most feared sports injuries. It’s important to recognize, however, that a damaged ligament also interferes with school, work, and even just everyday mobility. Because of this, it’s crucial for everyone—athletes and non-athletes alike—to recognize the signs of a torn ACL in order to seek immediate treatment from an orthopedic specialist.
Individuals with a sprained or torn ACL will experience:
- A distinct popping sound at the moment of their injury.
- A sudden and intense pain immediately following their injury.
- An inability to straighten or bend the knee all of the way.
- Severe swelling around the knee.
Types of ACL Treatment
RICE (Rest, Ice, Compression, and Elevation)
Individuals with a stretched or partially torn ligament (Grade I or Grade II), should utilize RICE (Rest, Ice, Compression, and Elevation) right after the injury. These methods will help reduce further ligament damage and help the body heal correctly. RICE is most effective during the first 72 hours of an injury.
- Rest: Refrain from using your knee. Consider using crutches and/or splints to ease movement.
- Ice: Apply ice or a cold pack to reduce swelling. Apply cold for up to 20 minutes, 3 or more times a day. Use a towel to avoid applying cold directly to the skin.
- Compression: Gently wrap the injured knee with an elastic bandage. Loosen the bandage if it causes numbness, tingling, increased pain, or increased swelling.
- Elevation: Keep your leg elevated above your heart level when sitting or lying down.
Individuals with a partially torn ACL should participate in physical therapy centered on developing their calf muscles, hamstring and quadriceps. A physical therapist will also teach patients how to modify their physical activities to put less stress on their knee.
Individuals with a ruptured ACL will need to see an orthopedic specialist about reconstructing the ligament via surgery. In an ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a tendon either from the patient’s body (auto graft), or one that has been donated (allograft).
Rehabilitation begins immediately after the procedure. The goal is to return the patient to their complete level of function in as short a time as possible. With that said, a full recovery can take anywhere from six months up to a year.
First Two Weeks after Surgery
Immediately following surgery, the knee will be swollen and difficult to bend. As with the initial injury, RICE will help manage the pain and swelling that follows surgery.
The knee will also be unable to bear weight, so patients will use crutches in order to remain mobile. Patients will learn exercises to perform daily in order to support their recovery.
Two to Six Weeks after Surgery
The knee will be able to bear weight but will remain vulnerable at this point. Although many patients become less dependent on crutches for mobility, a protective knee brace is used to protect the knee from unnecessary stress. Patients will also continue to participate in physical therapy programs to help regain their strength, stability, and full range of motion.
Six Weeks to Six Months after Surgery
After three months, many patients are able to perform low-impact activities such as light jogging as well as functional movements such as jumping. By six months, many patients have achieved a complete or nearly complete recovery. Patients who closely follow their doctor’s instructions and are committed to physical therapy are more likely to speed up the recovery process.
What to Do If You Have an ACL Injury
The first steps following an ACL injury are to apply first aid and then see an orthopedic specialist. Studies have shown that approximately 60% of patients with an ACL tear also have meniscus damage. If left untreated, an ACL injury will not only cause chronic knee instability, but the associated meniscal damage can also lead to osteoarthritis. In short, it’s imperative that athletes are proactive in seeking treatment.
At Beacon Orthopaedics and Sports Medicine, we provide a walk-in clinic in Northern Kentucky for immediate orthopedic care, as well as the ability to schedule an appointment online for any of our locations in the Greater Cincinnati. You can also download information about ACL tears and learn about other orthopaedic conditions.