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Anterior Cruciate Ligament (ACL) Tears

The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee. It attaches in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with the other ligaments of the knee, it provides rotational stability to the knee.

An ACL injury is an injury that occurs when the knee is forcefully twisted. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when a deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.

When you injure your ACL, you might hear a “popping” sound and you may feel as though the knee has given way. Within the first stages after injury, your knee will swell and you may have a sensation of instability in the knee during twisting movements.

Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament, and occasionally arthroscopic assessment.

Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, Mr Edwards and Mr Melton may recommend nonsurgical methods of treatment. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may well be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.

Those involved in pivoting sports or with a particularly active lifestyle may require surgery to safely return to sport/activity. The usual surgery for an ACL tear is an ACL reconstruction which replaces the deficient ligament and restores its stability. Surgery to reconstruct an ACL is done with an arthroscope using small incisions. Your surgeon will replace the torn ligament with a tissue graft that can be obtained from your patellar tendon or hamstring tendon. Following ACL reconstruction, a rehabilitation program with physiotherapy is started to help you to resume a wider range of activities. Your surgeons at The Cambridge Knee work with a variety of local physiotherapists in different areas and will be able to guide your choice.

RCS Logo British Orthopaedic AssociationRoyal College of Surgeons of EdinburghOTSISBritish Association for knee surgeryISOAMDU LogoOTSIS