Torn ACL symptoms and treatment
The anterior cruciate ligament (ACL) is one of the four major ligaments in the knee. It’s responsible for keeping the knee stable, preventing one bone from moving upon the other, and preserving the normal biomechanics of the knee. Sometimes called “the seatbelt of the knee,” the ACL can be stretched or torn due to sudden twists, turns or stops.
A torn ACL is the most common ligament injury in the knee that we see at Alexander Orthopaedics. Here, we’ll discuss some causes of ACL injuries, describe the range of severity, and introduce you to some treatment options. Ultimately, if you suspect that you’re experiencing an ACL injury, you should reach out to the dedicated, compassionate orthopaedists at Alexander Orthopaedic Associates for an evaluation.
What causes a torn ACL?
Most ACL tears occur due to a sport- or fitness-related injury. Typically the foot is planted and the knee locks and twists at the same time, causing the ligament to be torn. This can happen when changing direction rapidly, slowing down or stopping suddenly, landing from a jump incorrectly, or direct contact or collision.
How do you know if you tore your ACL?
Someone with a torn ACL typically experiences a popping sensation and the feeling that the knee is giving out underneath them, followed by severe pain and rapid swelling. Other torn ACL symptoms include:
- Difficulty walking and bearing weight
- Tenderness along the joint
- Loss of range of motion
- A feeling of instability
That being said, you don’t want to rely on self-diagnosis of an ACL injury. You should have your knee evaluated by a medical professional to determine whether a torn ACL is the cause of your pain or mobility concerns. If you’re experiencing these symptoms, rest your leg as much as possible to avoid further strain, and make an appointment with a specialist as soon as you can.
What are the risk factors for a torn ACL?
According to Harvard Medical School (HMS), female gymnasts and soccer players are particularly prone to ACL tears. Several other factors can increase your risk for an ACL tear, including:
- Participation in certain sports, including basketball, soccer, gymnastics and football.
- Using sports equipment that is poorly maintained, or wearing footwear that doesn’t fit properly.
- Women are more likely to tear their ACL due to their anatomy and muscle function.
- Like the rest of our body, the ACL also develops wear as you age. Physically active seniors are more at risk for ACL tears than their less active counterparts. However, treatment for ACL tears due to age is usually approached differently. More about that below.
Can you walk with a torn ACL?
Not all injuries result in a total destabilization of the knee. Every ACL injury is unique, and people will experience different levels of mobility issues. ACL injuries are classified by the following grading system:
- Grade 1: The injury is typically mild, characterized by microscopic tears that may stretch the ligament out of shape, but do not impact the overall stability of the knee joint.
- Grade 2: The injury is moderate, and the ligament is partially torn. The knee can be somewhat unstable and give way while walking.
- Grade 3: The injury is severe, and the ligament is torn completely in half, no longer providing stability to the knee joint.
You should not assume, however, that because you can walk on your ACL injury that you don’t need treatment, especially rest. Moreover, patients who experience any level of instability generally need reconstruction. Make sure to see an orthopedist to determine the severity of your injury.
What's the difference between a partial and complete ACL tear?
Tears in the ACL can be partial or complete. There are two bundles in an ACL, meaning the ACL is made up of two different strands of ligaments. Partial ACL tears occur when only one of the bundles tears, or one portion of one of the bundles tears.
According to Dr. Vladimir Alexander, a founding partner of Alexander Orthopaedics Associates, “partial tears can sometimes be left alone and can heal on their own, but certain people feel unstable even with a partial tear. If they feel unstable either clinically or sub-clinically — meaning the doctor can’t tell they’re unstable but the patient can tell they’re unstable — those patients generally need [their ACL] to be reconstructed, as well.”
Torn ACL treatment options
When you’re getting evaluated for an ACL injury, you will first receive a physical examination to identify swelling and bruising, as well as areas of tenderness and stability issues. The Lachman test, the anterior drawer test, and the pivot-shift test may also be used to evaluate the stability of the ACL.
After the physical examination, the doctor may order X-rays to determine whether or not there are any fractures. The physician may also perform the Lachman test to determine if the ACL is intact. An MRI scan can be ordered to assess other injury to the knee ligaments or cartilage.
Nonsurgical treatment
A torn ACL doesn’t heal on its own, but nonsurgical treatment is suitable for children patients, adult patients who are not very active, or patients with Grade I or Grade II tears.
- RICE (Rest, Ice, Compression, and Elevation): Initial treatment for a partial tear typically involves resting the joint, applying ice to the injured area, compressing the swelling with a bandage, and elevating the injured area.
- Medication: Taking a nonsteroidal anti-inflammatory, like ibuprofen, can ease swelling and relieve pain.
- Physical therapy: Learning rehabilitation exercises from a physical therapist can help you build strength in the leg muscles and regain range of motion in the knee.
- Knee braces: Wearing a knee brace can help protect the knee from instability.
- Additionally, Dr. Alexander says that, in cases where patients are older or have arthritic knees, the ACL is torn slowly over time. In these circumstances, reconstruction is not recommended, because it will actually make the knee too tight and create more bone-on-bone pressure, pain, and problems.
While not having surgery can lead to a quicker recovery, it’s also important to be careful in cases of complete tears. “If you don’t fix a complete ACL tear, they have abnormal biomechanics and they end up needing a knee replacement prematurely because the knee ends up wearing out prematurely,” says Dr. Alexander.
ACL surgery
For people in their 20s, 30s, and 40s as well as middle-aged adults who are active, surgery is typically recommended in cases of a complete tear. In ACL reconstruction surgery, the surgeon replaces the damaged ligament with a segment of tendon, which comes from another part of your knee or from a donor.
“There has been some push to do some ACL repair as opposed to reconstruction,” says Dr. Alexander. “That has been shown not to work very well. So, reconstructions have come back into favor as opposed to ACL repair. Those have a very high failure rate.”
Rehabilitation therapy is required after reconstruction surgery to restore stability and function to the knee.
Torn ACL recovery time
It can take anywhere from six to nine months to restore normal knee function. Walking on a torn ACL, bending your knee, or putting weight on it too soon can increase damage and pain, but it depends on the grade of the injury. If the injury is mild, you might be able to walk on a torn ACL after a few weeks of rehabilitative therapy.
It’s essential to work with an experienced physical therapist and surgeon to recognize the right balance of exercise and rest to rehabilitate the knee in the best way possible.
At Alexander Orthopaedics, we work with you to develop a personalized treatment plan for your torn ACL diagnosis, treatment and recovery.
What not to do after ACL surgery
To help your knee recover as quickly as possible, try to avoid a few common mistakes that postoperative patients sometimes make:
- Avoid rushing your recovery, and putting too much pressure on your leg. Recovery can be a lengthy process, but taking your time is worth it in the long run.
- By the same token, don’t overcompensate with your other leg. This can cause injury, as well. Keep your weight as evenly distributed across both legs as possible.
- Overicing can lead to nerve damage. Limit icing to 20 minutes 3-4 times a day.
- Don’t forget your knee brace at home. We know that your knee brace can be hot and uncomfortable, but it’s a vital part of recovery and further injury prevention.
- Don’t cut corners during physical therapy. It’s one of the most important components of recovery. Complete your exercises according to the schedule provided by your PT.
- Try not to sleep with your knee bent, which can cause a buildup of scar tissue.