Anterior Cruciate Ligament Sprain (Torn ACL)

ACL sprain

An ACL sprain is a tear of the anterior cruciate ligament in the knee joint. Here we explain the symptoms, causes and treatment for a torn ACL.

Torn ACL symptoms

Torn acl diagnosis

ACL tears usually occur as a result of a twisting movement when your foot is in contact with the ground.

  • The main symptom on the field of a torn ACL is usually sudden pain in the knee.
  • In most cases, you will be aware that something serious has happened. Some patients describe an audible pop or crack at the time of injury.
  • Swelling in the knee usually develops rapidly, but not in all cases. Your knee may also feel very unstable.
  • Your knee will also become warm to touch.

The rapid swelling is caused by bleeding within the joint. This is due to ruptured blood vessels around and within the ACL which causes bleeding into the joint cavity.

Assesment

A professional thereapist will do a number of assessment tests to help diagnose your ACL sprain. These include:

Imaging

An MRI scan can confirm the diagnosis of an ACL sprain. An X-ray is only useful to detect a bony injury such as an associated avulsion fracture. This is where the ligament tears, pulling a small piece of bone away with it.

What is an ACL sprain?

acl sprain

An ACL sprain is a tear of the anterior cruciate ligament in the knee. This can either be a partial tear or a full tear (rupture) depending on the force of the injury.

The anterior cruciate ligament runs diagonally across the knee. It originates from the back of the femur (thigh bone) and attaches to the front of the tibia. Its function is to prevent the tibia (shin bone) from moving excessively forwards.

What causes ACL injuries?

Injuries to the ACL usually occur as a result of either a twisting force in the knee. This can happen when landing after a jump. The foot is planted on the ground, whilst the knee twists inwards.

Although less common, you may also sustain an ACL injury from contact with opponents, particularly in sports such as rugby or football.

A direct blow to the outside of the knee causes it to buckle inwards. This causes excessive movement of the tibia (shin bone) resulting in damage to other structures within the knee, as well as a torn ACL.

Skiing is also a common cause of ACL sprains. The tips of the skis dig into the snow causing the knee to twist.

Treatment for ACL sprains

Treatment consists of immediate first aid, taping/bracing and rehabilitation exercises. If you believe that you have a suspected ACL injury or tear, you should seek professional advice as soon as possible.

Cold therapy & compression

Cold knee compression wrap

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Immediate first aid for ACL tears involves applying the P.R.I.C.E. therapy principles (protection, rest, ice, compression, and elevation) to reduce pain and swelling.

Apply a cold compression wrap for 15 minutes every hour or so for at least the first 72 hours. Or until you have had the knee assessed by a professional therapist or doctor. Do not apply ice directly to the skin as it may burn.

Wear a knee brace

Wear a knee support or brace to help protect your knee, especially if it is unstable. Knee braces vary considerably in price, and the amount of support they offer.

A hinged knee brace has solid metal supports down the sides to give extra support to protect the ligaments. It is not possible to brace, tape or support the knee to completely prevent injuries.

Knee taping

The aim of using a brace or acl taping is to support the knee following injury and to make the athlete feel more confident to move around. Taping is important if your knee is unstable as it will help protect other structures (ligaments and cartilage).

Do not tape if you are unsure of the injury, or the purpose of taping the knee. This can sometimes give you a false sense of security and you may damage the knee even more.

Seek professional advice

If you suspect a torn ACL then it is important you see a doctor or professional practitioner who can make a full diagnosis. This may not be possible until swelling has reduced.

They are likely to send you for an MRI scan or X-ray to confirm the diagnosis and depending on the result, they may advise you to see an orthopedic surgeon.

Exercises for ACL sprain recovery

Heel slide exercise

Once you have a diagnosis and the initial acute stage has passed, the first stage of ACL injury rehabilitation begins. Here the aim is to regain normal movement as soon as safely possible through mobility exercises.

In cases where surgery is the treatment of choice, your surgeon will often delay the timing of your operation. This allows time for the swelling to go down and normal movement regained before reconstructing the ligament.

If you opt for the conservative route (without surgery) then you will progress through a rehabilitation program which should include the following exercises.

  • Mobility exercises to restore normal range of movment in the knee.
  • Proprioception exercises (movement control) to restore spacial awareness and reduce the risk of your injury recurring.
  • Strengthening exercises
  • Functional exercises bridge the gap between basic rehab exercises and full sports training.

Surgery

Surgery for a torn ACL is not always required. Whether you are advised to have surgery or not will depend on the level of sport and competition you perform at.

You may be advised to follow a non-surgical (conservative) approach.

References:

Boden B.P., Sheehan F.T., Torg J.S. and Hewett T.E. (2010) Non-contact ACL Injuries: Mechanisms and Risk Factors Journal of the American Academy of Orthopaedic Surgeons 18(9) pp 520-527

Magnussen R.A., Reinke E.K., Huston L.H., Hewett T.E. and Spindler K.P. (2016) Factors Associated with High-Grade Lachman, Pivot Shift and Anterior Drawer at the Time of Anterior Cruciate Ligament Reconstruction The Journal of Arthroscopic and Related Surgery 32(6) pp 1080-1085

Culvenor AG, Eckstein F, Wirth W, et al. Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial Br J Sports Med Published Online First: 08 February 2019.

Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 2005;39(3):127–31

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This article has been written with reference to the bibliography.
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