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Normal ACL vs Torn ACL

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An ACL injury is a tear or sprain of the anterior cruciate ligament— one of the major ligaments in your knee. ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing — such as soccer, basketball, football and downhill skiing.

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Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee. The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.

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Signs and symptoms of an ACL injury usually include:

A loud "pop" or a "popping" sensation in the knee

Severe pain and inability to continue activity

Rapid swelling

Loss of range of motion

A feeling of instability or "giving way" with weight bearing

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Your doctor may recommend surgery if:

You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting

More than one ligament or the meniscus in your knee is also injured

The injury is causing your knee to buckle during everyday activities

During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon — tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. After surgery you'll resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee. There's no set time frame for athletes to return to play. Recent research indicates that up to one-third of athletes sustain another tear in the same or opposite knee within two years. A longer recovery period may reduce the risk of reinjury. In general, it takes as long as a year or more before athletes can safely return to play. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk for ACL injury.

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Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. Follow the R.I.C.E. model of self-care at home:

Rest. General rest is necessary for healing and limits weight bearing on your knee.

Ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.

Compression. Wrap an elastic bandage or compression wrap around your knee.

Elevation. Lie down with your knee propped up on pillows.

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There are a number of factors that increase your risk of an ACL injury, including:

Being female — possibly due to differences in anatomy, muscle strength and hormonal influences

Participating in certain sports, such as soccer, football, basketball, gymnastics and downhill skiing

Poor conditioning

Wearing footwear that doesn't fit properly

Using poorly maintained sports equipment, such as ski bindings that aren't adjusted properly

Playing on artificial turf surfaces

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During the physical exam, your doctor will check your knee for swelling and tenderness — comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint. Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include:

X-rays. X-rays may be needed to rule out a bone fracture. However, X-rays don't show soft tissues, such as ligaments and tendons.

Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.

Ultrasound. Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

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Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint. ACL injuries often happen during sports and fitness activities that can put stress on the knee:

Suddenly slowing down and changing direction (cutting)

Pivoting with your foot firmly planted

Landing awkwardly from a jump

Stopping suddenly

Receiving a direct blow to the knee or collision, such as a football tackle

When the ligament is damaged, there is usually a partial or complete tear of the tissue. A mild injury may stretch the ligament but leave it intact.

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Seek immediate care if any injury to your knee causes signs or symptoms of an ACL injury. The knee joint is a complex structure of bones, ligaments, tendons and other tissues that work together. It's important to get a prompt and accurate diagnosis to determine the severity of the injury and get proper treatment.