Many sports fans will recognise the term “torn anterior cruciate ligament”, an injury suffered by high-profile sportsmen and women including Lawrence Dallaglio, Paul Gascoigne, Michael Owen, Tiger Woods and Abbey D’Agostino.
But what causes a torn ACL, how can it be treated, what is the recovery time and what should you do if you think you have injured your anterior cruciate ligament?
What is the ACL?
The cruciate ligaments in the knee are tough pieces of tissue connecting the femur (thighbone) to the tibia (shin bone) that help to keep the knee joint stable.
The ACL, one of the central ligaments, is a primary stabiliser of the knee and helps to hold it together. Unfortunately, the ACL does not heal very well and if the ligament gets significantly injured, the knee can become unstable in some directions. The degree of instability varies depending on the amount of stress and strain put on the knee and the degree of instability inherent in the knee.
For example, getting on with everyday life can be fine but taking part in sports that require twisting and turning, such as football, netball or skiing can be very difficult or even impossible.
In recent years, more women seem to be tearing their ACLs than ever before. This could be due, in part, to more women taking part in sports such as football, netball and skiing as well as hormonal and anatomical factors.
What causes a torn ACL?
A torn ACL (also known as a ruptured ACL, a strained ACL or a sprained ACL) is usually damaged while playing sport, either as a result of a contact injury or a non-contact injury.
Examples of a contact injury include when a footballer is tackled and the violence of the injury exceeds the strain the ligament can bear.
Examples of a non-contact injury include when a rugby player’s upper body twists but the lower body stays still as their studs grip the ground.
ACL injuries almost always start with an event that causes immediate pain and a popping sensation, sometimes accompanied by a popping sound. Because of the release of different chemicals inside the blood, people will often feel nauseated. Typically, when they try to get up again, the leg feels unstable and wobbly, and they are unlikely to play on. Swelling in the knee usually follows within an hour or two.The knee often settles down in the days after the initial injury and many people wrongly believe they have made a good recovery. They will often only realise the extent of their injury when they return to the football pitch or the netball court and their knee quickly buckles as soon as they start twisting it.
What are ACL injury symptoms?
Symptoms can include:
- Swelling of the knee
- Locking of the knee (the knee gets stuck and it’s difficult to straighten it)
- The knee giving way
- Restrictive moment (not being able to bend the knee or straighten the leg)
- Swelling in the calf (there is a small incidence of deep vein thrombosis as a complication of an ACL knee injury)
When should I contact a doctor?
You should contact a doctor as soon as possible after the original ACL knee injury if:
- You felt the popping sensation at the time of the injury
- Your knee swelled up
- Your knee was painful
- You struggled to bear weight on your knee
In 90% of such cases, this will mean a torn ACL. If you cannot straighten your leg you should contact a doctor urgently. (This is often caused by a bit of broken ligament getting caught in the joint, which needs to be dealt with urgently.)
Treatment for an ACL tear: An introduction
Keyhole surgery to reconstruct the ruptured ligament is advised in some cases. But decisions about going ahead with ACL reconstruction surgery depend on the level of stability and whether people want to continue playing particular sports. For example, some people will say that, in order to avoid having ACL surgery, they are prepared to give up football or skiing.
What non-surgical treatment is available?
Non-surgical treatment is based on a rehabilitation programme of physiotherapy, core strength and conditioning exercises and the support of a knee brace for some sports.
This is enough for some patients and gives them the stability they need to get on with their everyday lives.
When is ACL reconstruction surgery required?
ACL reconstructive surgery is for those whose instability stops them from doing what they want to do. In the case of a sports enthusiast, that could be playing football. In the case of an older person, that could mean comfortably walking to the shop. An operation is also for people who have tried non-surgical treatment but still feel wobbly or unstable. After surgery, patients can usually expect to go back to the everyday stability they enjoyed before injury.Getting back to pre-injury sports performance depends on the individual and their rehabilitation. At the elite level, about two-thirds of professional sportsmen and women will be back to a similar level of activity as before. Among that group, most people will be about 95% back to their best.
Special case: Adolescents/young adults
Evidence suggests that young people who are unstable because of a ligament injury are more likely to suffer secondary damage in the form of a meniscus tear (meniscus cartilages are rubbery cushions of flexible tissue that lie between the major bones of the knee and act as shock absorbers). A torn meniscus increases the risk of developing arthritis in later life so we generally recommend ACL reconstruction surgery for all younger patients.
What is ACL injury recovery time?
- Everyday activity, such as going into the office: 2-3 weeks
- Driving a car/feeling comfortable on public transport: 4-6 weeks
- Gym-based exercise: 6 weeks
- Return to contact sport: More than 6 months
How can Wimbledon Clinics help with an ACL tear?
If you are suffering from a torn ACL or any other knee injury, please don’t take any chances. It’s crucial that you get absolute clarity on a knee diagnosis.
At Wimbledon Clinics, we are the sports injury experts so we can give you the best advice about how to overcome your knee problems and get back to your best as soon as possible. When you come to see us, we can assess your injury and put together a clear strategy for your treatment and recovery.
For a free phone consultation or to book an appointment, call Wimbledon Clinics now on 020 8629 1889 or email [email protected]
Alternatively, click here to book your free phone consultation.