Dr. Paul E. Caldwell, Arthroscopy and Sports Medicine, Tuckahoe Orthopaedics, Ortho, OrthopaedicsBy Paul E. Caldwell, MD

A torn anterior cruciate ligament (ACL) is one of the most common and painful of sports injuries. It’s common because so many popular sports (soccer, football, basketball, skiing, etc.) involve cutting, pivoting and extension of the legs during the sport. It’s painful because it involves the ligaments in your knee, which is the most nerve-rich joint in your body.

What is the ACL?

There are four ligaments in your knee:  the medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL), and the posterior cruciate (PCL). The ACL is located in the middle of the knee. It stops the tibia (shin bone) from sliding out in front of the femur (thighbone). The PCL works with the ACL as it stops the tibia from sliding backward and under the femur.

All four ligaments work together to provide stability to your knee. When you extend or force any of these ligaments past their limits you may either strain or tear them. Torn ACL’s require surgery to correct the tear if you expect to return safely to any kind of physical activity.

How ACL Tears Happen

Most ACL tears occur as a result of twisting, hyperextending the leg, or pivoting – common moves in sports, especially football, basketball, soccer, tennis and skiing. ACL injury often occurs as a non-contact injury resulting in strains and tears.

Interestingly enough, women experience ACL tears more often than men, possibly due to estrogen levels making their joints looser. Therefore, younger women and girls are at greater risk for ACL tears; however, women of all ages tend to have weaker quadriceps (muscle) and less control over their knees than men. In addition, anatomy and muscle function of the knee is different in women than in men thereby resulting in a tendency toward women having more knee injuries.

4 Symptoms and Signs of a Torn ACL

There are several types of injuries that can cause pain in the knee, but a torn ACL has four specific qualities:

  1. At the moment of injury you may hear a pop or popping sound.  You may also feel a pop when the ACL tears. It is a very distinct sound and feeling.
  2. A very sudden and intense onset of pain.  Most athletes report feeling a searing, burning, or intense pain immediately after the popping sound.
  3. Lots of obvious swelling in the affected knee within the first five to six hours.  The swelling is brought on by blood and fluids from the tear flowing in and around the injured area.
  4. Can’t straighten or bend the knee all the way and the knee feels tight.  You usually can’t put any weight on the knee without it collapsing or being very painful. Strains or sprains of the ACL may lead to a feeling that the knee is unstable or the knee may actually give way when you try weight bearing.

Recovering From An ACL Tear

Most people who do not see a specialist right away resume their lives once the swelling from an ACL tear subsides. After a few weeks of rest, ice and painkillers, the knee will begin to feel normal and most people assume it has healed, but that is quite the opposite.

Unlike torn muscles, a torn ACL does not heal by itself. Just because the knee feels better in a week or two doesn’t mean it is better. Before returning to any sports or physical activity, the knee should be checked. If the ACL is torn and nothing is done about it, returning to playing sports can cause re-injury to the knee. If the knee buckles a second time, there is risk for tearing the meniscus and other cartilage in the knee, thus making the injury even worse.

A successful recovery of an ACL tear can take up to a year. It’s important that during this time you find an orthopedic specialist to assist in your recovery. Even if you do not plan to return to a particular sport, it’s important that a physician addresses your ACL tear. The physician can assist you with various courses of treatment from physical therapy to surgery.

If you think you may have a torn ACL or need help navigating the recovery process, contact us today to make an appointment.


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