ACL Injuries

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Written by: Dr. Trevor L. Hall, MD, CCFP, Dip. Sport Med., Sports Medicine Physician

Acute Knee Injuries: ACL tears

“I blew out my knee!” Have you ever yelled out this phrase? Traumatic knee injuries are very common in sports such as football, hockey, soccer and basketball (sports that involve pivoting). One of the more serious injuries involves the anterior cruciate ligament (ACL).

What Is the Knee ACL?

A ligament is a rope-like structure that holds two bones together. In your knee, there are four main ligaments. The ACL is one of those ligaments and acts to prevent the tibia (shin bone) from shifting too far forward in relation to the femur (thigh bone). The ACL also helps to prevent rotational movements between these two bones.

How do ACL Tears Happen?

Sports that involve a lot of pivoting, stops and starts, landing jumps, and contact between players have a higher risk of ACL injuries. Usually, if you tear your ACL, there is considerable pain, swelling that occurs quickly, and occasionally a “pop” sensation.

How is an ACL tear diagnosed?

A physician who has experience at diagnosing ACL injuries should be able to tell the extent of injury through physical examination. ACL tears can be a complete or partial (“stretching”). Only rarely would special tests such as magnetic resonance imaging (MRI) be required to diagnose an ACL tear. X-rays are usually done to make sure that you have not sustained any bone injury.

How do You Treat an ACL Tear?

The initial treatment of ACL tears involves measures to decrease the swelling such as frequent icing and using a non-steroidal anti-inflammatory medication (e.g., naproxen). Physiotherapy is very important in regaining your knee range of motion and preventing excessive muscle wasting. Often, the physician will prescribe a temporary brace for the first two weeks to protect your knee. Once your knee starts to settle down, the physiotherapist will show you some particular strengthening (especially hamstring strength) and balance exercises, which are very important in the rehabilitation of your knee.

What is the Best Physiotherapy for ACL Treatment?

There are many factors that will affect your decision for which physiotherapist you see for your injury. Click here for more details on how to choose a physiotherapist. LINK. Regarding ACL tears, you should seek a physiotherapist who has expertise in treating sports injuries and specifically treating ACL tears. 

The basic treatment for ACL tears can be straightforward, however, if complications arise or if you are trying to optimize the recovery of your knee, you should seek a physio with extra skill and knowledge in this area. For example, once the recovery process is underway you will need to progress to doing some complex neuromuscular retraining exercises that are specific for your sport or activity which are based on current research validated recommendations. Also, after surgery, you need to carefully guided through the post-surgical recovery process by your physiotherapist to prevent stiffness and to optimize strength and function for a full return to sports.

How Long does it take to Recover from an ACL Tear?

For an isolated ACL tear, your knee should be feeling much better within 6 weeks (no pain or swelling because the inflammation has settled down). Unfortunately, the torn ACL does not usually heal or “tighten up”. Once an ACL is completely torn, it stays torn.

The big problem with this situation is that an ACL-deficient knee does not function properly. If you return to a contact sport or a sport with a lot of pivoting (football, hockey, soccer, basketball, etc.) your knee will probably give out again (“blow out” your knee all over again). Every time your knee gives out (knee instability), you risk causing other damage to your knee such as cartilage tears and possibly long-term problems such as osteoarthritis.

Does a brace help ACL Tears?

An ACL brace can help to prevent this knee instability. A physician may prescribe a special custom-fit ACL brace. This type of brace can be used on a daily basis in the rehab period and later to help to prevent knee instability in high risk situations such as pivoting or contact sports. In general, these braces are well-tolerated since they are custom-fit and made of strong light-weight materials such as titanium and carbon-fibre.

Is Surgery Needed for ACL Tears?

Depending on your sport or activity level, you may have to have surgery to reconstruct your ACL. Surgical reconstruction comes the closest to getting your knee back to normal. If your sport does not involve any pivoting (e.g., road cycling) then you probably will not need surgery (unless your knee gives out with daily activities which can sometimes happen!).

Surgery is usually the best option for individuals who play football and other pivoting and contact sports. In the realm of sport injuries, ACL surgery is a fairly large procedure since the surgeon has to be skilled at this type of procedure. You have to be very dedicated to working hard at physiotherapy for several months after surgery, to help ensure a successful outcome.

In general, the earliest you can return to contact & pivoting sports after ACL surgery is six months. Often, this period is closer to nine months. Going back too early can result in re-injury since the reconstructed ACL will not be strong enough. Usually, you will be using the ACL brace after surgery, during the rehabilitation, and for the first year afterwards.

In summary, although an ACL tear is a major injury, it is not the end of the world. With appropriate treatment, most players are able to return to the same level of activity they were at prior to injury.

girl on bleacher drinking water with knee brace on
Diagram of football player twisting knee
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