Education and Expectations for an
Anterior Cruciate Ligament (ACL) Tear
You’ve likely heard the term ACL or even know someone who has injured theirs, but may not know what exactly it is. An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament (ACL) in the knee, partially or completely. An ACL tear is an injury to the knee commonly affecting athletes, such as soccer players, basketball or football players, skiers, gymnasts, etc. Nonathletes can also experience an ACL tear due to injury or accident. Approximately 200,000 ACL injuries are diagnosed in the United States each year. It is estimated that there are 95,000 ruptures of the ACL and 100,000 ACL reconstructions performed per year in the United States. Approximately 70% of ACL tears in sports are the result of noncontact injuries, and 30% are the result of direct contact (person-to-person, person-to-object). Physical therapists are trained to help individuals with ACL tears reduce pain and swelling, regain strength and movement, and return to desired activities.
Anatomy of the Knee 
The knee is made up of four ligaments that support the knee during movement: the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL.) The knee is also made up of two discs of cartilage, the medial meniscus and lateral meniscus, that work as shock absorbers within the knee joint. One of the most important stabilizing structures of the knee is the ACL. The ACL attaches the front of the shin bone (tibia) to the back of the thigh bone (femur) and acts to prevent increased forward motion of the tibia on the femur.
ACL Injury and Diagnosis
The ACL is the most injured ligament of the knee. Injury to the ACL usually occurs during high intensity sports, recreational, or work activities where deceleration is accompanied with cutting or twisting of the knee. This can also be accompanied with an audible pop. Injury of the ACL will result in immediate swelling of the knee, decreased range of motion, pain, and unsteadiness with walking. If the injury is significant enough, the ligament on the inside of your knee, the MCL, and the cartilage between the thigh and shinbone, the medial meniscus, can also be injured.
To specifically test the integrity of the ACL, your doctor can perform special tests such as the Lachman’s test and Anterior Drawer test which give information about the stability of the ACL. If your doctor determines these tests are positive, an MRI may be done to officially diagnose the tear.
These results can either diagnose a partially or completely torn ACL. These patients will complete physical therapy to address the symptoms of instability at the knee. Although patients recover close to pre-injury status, people will still struggle with instability of the injured knee. A completely torn ACL usually results in surgery, leading to a longer recovery process.
ACL Surgery
Arthroscopic surgery is usually the path that is taken to repair an ACL tear. A tendinous autograft, defined as a tendon harvested from the same individual’s body, can be taken from the hamstring tendon, patellar tendon, or the quadriceps tendon which is then used to replace the torn ACL. Another tendon that could be used is called an Allograft, which is a graft taken from a cadaver. The graft that is taken is determined on a case-by-case basis by the orthopedic surgeon. Surgery usually consists of harvesting the graft, inserting the graft into the knee joint, and testing the graft to make sure it is secure, and the patient has full range of motion. It is common to have pain in the knee after surgery.
ACL Post-Operative Physical Therapy
Right after surgery, a brace will be placed on the knee and crutches will be used when walking. Most doctors have a specific post-surgical protocol to follow, and the recovery process lasts around six to nine months. Physical therapy is usually begun a day or two after surgery. The first month or so of physical therapy will focus on decreasing pain and swelling, regaining full range of motion of the knee, and improving strength of the quadriceps and hamstring muscles. As weeks progress, intensity of exercises increases to improve functional strength and mobility of the injured knee. After clearance from the orthopedic surgeon, the final stage of therapy, AKA the return to sport stage, can begin. This occurs around the six-to-seven month mark post-surgery. Here, sport related activities are done in therapy to prepare the knee for returning to high level sports activities.
The ACL is a very important structure of the knee and provides support and stability for high intensity, sport related movements. Physical therapy is a crucial part of the recovery process to help people return to their prior level of function as well as prevent future injuries.
As movement experts, Axes physical therapists improve quality of life through hands-on care, patient education, and prescribed movement. If you have injured your ACL, you can contact an Axes physical therapist directly for an evaluation – we will help you direct your care through your primary care physician and get you to a surgeon, if necessary.
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