Symptoms and Recovery for ACL Tears

An anterior cruciate ligament (ACL) tear is a knee joint injury that usually occurs while playing sports. It causes leg pain and instability of the knee. This is one of the most common injuries among recreational athletes of all ages.

A physical examination diagnoses an ACL tear. However, an imaging study, such as an X-ray, may be needed to determine whether you also have other injuries (like a bone fracture).

Depending on the extent of your injury and the severity of your symptoms, you may need treatment with physical therapy, a supportive brace, or surgery. Often, rehabilitation is part of recovery after surgical treatment.

This article will discuss the symptoms and causes of ACL tears along with diagnosis and treatment.

What Are ACL Tears?

A ligament is a strong band of connective tissue that attaches bones, providing stability.

The ACL is one of four major knee ligaments. Along with the posterior cruciate ligament and the medial and lateral collateral ligaments, it helps provide stability for your knee. The ACL is located in front of your knee, and, along with your posterior cruciate ligament, it forms a crisscross shape across the lower surface of your thigh bone and the upper surface of your shin bone to stabilize them.

It can rip when your leg movements stretch or pull this ligament. The size of the injury varies from a slight tear of connective tissue fibers to a complete tear and detachment.

Symptoms of ACL Tears

You may hear a sudden pop and/or feel a sudden shift in your joint at the time of an ACL injury. Most people are surprised at how loud the pop can be, and sometimes bystanders can even hear it on the sideline of a football or soccer game.

Right after an ACL tear, you can rapidly develop hemarthrosis (bleeding into your joint). This causes:

• Swelling
• Redness
• Warmth
• Bruising
• Pain
• A bubbling sensation in the joint

With an ACL tear, your joint will be unstable and prone to give out. This can occur when you are participating in sports or even with simple movements like walking or getting into a car.

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

• Knee pain or swelling that lasts more than 48 hours
• Trouble standing or walking on the affected knee
• Inability to support your weight on the affected knee
• A deformed or odd appearance on one side of your knee

Sports Ability After an ACL Tear

Athletes often have difficulty after experiencing an ACL injury. Soccer, football, and basketball rely on your ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.

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

Causes of ACL Tears

An ACL tear is most often a sports-related injury, but it can also occur during rough play, motor vehicle collisions, falls, and work-related injuries.

About 60% to 70% of ACL tears occur without contact with another athlete. Typically, an athlete suddenly changes direction (cutting or pivoting), which causes excessive stretching and tearing of the ligament.

ACL Tears in Women

Female athletes are especially prone to ACL tears. Research has shown up to an eight-fold increase in the number of ACL tears in female athletes compared with their male counterparts.

The reason for the increased risk has been debated for decades, and experts now believe that differences in neuromuscular control cause it. Men and women position the knee differently during critical sports movements such as landing, cutting, and pivoting. The differences in male and female anatomy and hormone levels may also factor into the different rates of ACL tears.

Diagnosing ACL Tears

The diagnosis of an ACL tear relies on several methods. Along with listening to your symptoms, your healthcare provider will perform a physical examination and assess your knee mobility, strength, and swelling.

Your healthcare provider can evaluate the ligaments of your knee with specialized maneuvers that test the stability of your knee, including:

• Lachman test: The Lachman test is performed to evaluate the forward movement of your tibia (shin bone). Your healthcare provider can feel for an ACL tear by pulling the tibia forward. Your knee is slightly bent (about 20-30 degrees), and your femur (thigh bone) is stabilized while your tibia is shifted.
• Drawer test: The Drawer test is performed with your knee held with a 90-degree bend. Your tibia is shifted forward and back to assess your ACL by pulling forward, and your PCL is assessed by pushing back.
• Pivot shift maneuver: The pivot shift is difficult to perform in the office and is usually more helpful in the operating room under anesthesia. The pivot shift maneuver detects abnormal knee joint motion when there is an ACL tear.

Your leg strength and other major knee ligaments will also be assessed during your physical examination.

Imaging Tests

You may also need an X-ray of your knee, which can identify bone fractures. A magnetic resonance imaging (MRI) study may also determine whether your ligament is torn, whether you have sustained damage to your cartilage, and look for signs of other associated injuries in the knee.

Remember that while MRI studies can help diagnose injuries in and around your knee, an MRI is not always needed to diagnose an ACL tear.

Grading ACL Tears

ACL sprains are graded based on how much the ligament is damaged.

• A Grade 1 sprain is a minor stretching to the ligament, and your knee is still reasonably stable.
• A Grade 2 is a partial ACL tear, with the ligament stretched so much that it is loose and damaged. These are relatively rare.
• Meanwhile, in the more common Grade 3 sprain, there is a complete tear of the ACL, with the knee joint becoming unstable and surgery almost inevitable if it is to be corrected.

Treatment of ACL Tears

Conservative Management

If you have a partial ACL tear, you may benefit from conservative management, which can include a combination of rest, pain control, and management of the swelling. Eventually, you can start physical therapy and/or use a knee brace. Physical therapy for a partial ACL tear includes strengthening, balance, and range of motion exercises.

Nevertheless, even if you don't experience any pain, you might continue to have persistent symptoms of knee instability. Several important factors need to be considered when deciding on ACL surgery. You need to consider the frequency and severity of your symptoms and whether you are prepared to undergo surgery, postoperative rehabilitation, and healing.

Surgery

The usual surgery for an ACL tear is called an ACL reconstruction. Since a repair of the ligament is not usually possible, it is reconstructed using another tendon or ligament.

There are several approaches to ACL surgery, and your healthcare provider will explain which is best for you. For example, several types of grafts can be used to reconstruct the torn ACL. Your practitioner can use one of your ligaments, or you can use a donor graft. Typically, using your ligament results in more potent healing.

The procedure also has variations, such as the new "double-bundle" ACL reconstruction.
Risks of ACL surgery include infection, persistent instability, pain, stiffness, and difficulty returning to your previous level of activity.

The good news is that most people do not have any complications after ACL surgery.

Post-Surgical Rehabilitation

Post-surgical rehabilitation is one of the most important aspects of healing. Exercises focus on restoring motion and strength and improving joint stability to prevent future injuries.
You can learn to do some exercises on your own while advancing at a steady pace.

Progressing too quickly or too slowly can be detrimental to your overall results from surgery, so you must continue to work under the guidance of your therapist and your healthcare provider throughout your recovery.

Braces

You may need to use a knee brace after ACL reconstruction surgery. These braces are designed to limit your range of motion, help stabilize your knee, and allow your ACL to heal properly.

Not everyone needs a knee brace after surgery; this decision is based on how much support your knee needs while healing.

Kids & Surgery

The decision about ACL surgery for children requires consideration of several factors that are not relevant to adults. Surgery increases the risk of growth problems in children. ACL surgery can cause growth plate disruptions, such as early growth plate closure or alignment deformities.

Summary

Preventing ACL tears is essential. You may be at a higher risk of having one if you are an athlete or if you have had one before, even if it was surgically repaired.

Neuromuscular training may help improve muscle control and reduce the chances of sustaining these types of injuries.

If you have had an injury, you must wait long enough to heal before you return to playing. This can be difficult, especially for professional athletes and students with athletic scholarships. Experts recommend waiting six to 12 months after a significant ACL injury before returning to play. In the meantime, it is essential to continue safely training so your muscles will stay strong and not experience muscle atrophy.