Understanding ACL Tears: A Comprehensive Guide

By Drew Heideman, PT, ATC

ACL Tears

Anterior Cruciate Tear or ACL Tear

ACL tears can be a very painful and debilitating injury that weakens and destabilizes the knee. Also, this can be the worst news a sports medicine physician can bring to his coach or report to bring to his weekend warrior patient for his or her coach. Until about 15 years ago, a knee injury such as this often ended an athlete’s career. Furthermore, attempts at ACL reconstruction were often met with stiff or arthritic knees because the types of repairs or reconstruction were not biomechanically sound.

ACL Tears: An In-Depth Exploration

Anterior Cruciate Ligament (ACL) tears, also known as torn ACL, are common knee injuries often resulting from sports activities or accidents. These ACL injuries can cause significant pain, instability, and limited mobility. Here at JOI Online, we strive to provide comprehensive, easy-to-understand information about ACL tears. Whether you’re an athlete, a sports enthusiast, or simply seeking knowledge about knee injuries, our content is designed to help you gain a deeper understanding of this condition.  If you have any questions, give us a call.

The Anatomy of the Knee

The knee joint is a complex structure, and the anterior cruciate ligament plays a significant role in its stability. The cruciate ligament, specifically the ACL, is located deep within the knee joint and is one of the four major ligaments that connect the bones and provide support to the knee. It is composed of strong, fibrous tissue that maintains the integrity of the joint during various activities. The ACL works closely with other ligaments and structures in the knee to maintain overall joint stability.

Each year in the NFL and the NBA, a big-time athlete has a tear of the anterior cruciate ligament (ACL) of the knee. It has been said when God designed the ACL, he obviously was not thinking of the NFL or NBA. In the general public, occurrence of an ACL injury is about 50 per 100,000 people per year. Snow skiing is the most common sport for ACL tears with over 25,000 per year.

Basic research in sports medicine has now led us to improved procedures. I can now reconstruct and make new ACLs which are as strong as the body’s original ACL. Newer techniques and arthroscopic surgery have reduced the amount of trauma to the knee. In this country, tissue from other parts of the body or the knee is used for the new ACL.

What Causes ACL Tears?

ACL tears are frequently caused by sports that involve sudden stops, changes in direction, or jumping. Basketball, soccer, skiing, and gymnastics are common activities that can result in an ACL injury. However, non-contact ACL injuries can also occur. Certain risk factors increase the likelihood of a torn ACL, such as gender, previous ACL injuries, and improper landing techniques. In addition, traumatic events and accidents like falls, car accidents, and workplace injuries can also lead to ACL tears.

Symptoms to Look Out For

Common ACL tear symptoms associated with ACL injuries include pain, swelling, and instability in the knee, difficulty walking or bearing weight on the affected leg, and a popping or snapping sound at the time of the injury. These are known as ACL injury symptoms. If you are experiencing these ACL pain symptoms, it’s important to seek professional medical advice. At JOI Online, we offer comprehensive orthopedic services to help diagnose and treat ACL tears.  Our experienced team of orthopedic physicians and rehab clinicians work together to ensure you have the best outcome.

Diagnosing ACL Tears

Our JOI Physicians use a combination of physical examination techniques and imaging tests to diagnose ACL tears accurately. During the examination, your physician will assess the stability, range of motion, and overall functionality of your knee joint. In addition to a physical examination, imaging tests like Magnetic Resonance Imaging (MRI) and X-rays are used to provide a comprehensive evaluation of the ACL injury and to rule out fractures. It’s essential to consult with a specialist in orthopedics or sports medicine for an accurate diagnosis and personalized ACL treatment plan.

Patellar Tendon Grafts

The most popular ACL reconstruction performed today is using a strip of the patellar tendon. Which is the tendon that connects the kneecap to the tibia or lower bone below. A 1 cm strip of this tendon and a small piece of bone from the kneecap and the lower tibia are harvested at the beginning of the procedure. I then drill holes in the exact location of the previous ACL, this forms the new ACL. An allograft or cadaver patellar tendon replaces the ACL. The cadaver graft is frozen to for a later time.

Hamstring Tendons Grafts

Reconstructions using the hamstring tendons are also popular in many areas of the United States. Advances in the treatment of ACL injuries are not confined just to surgical treatment. In recent years, an increasing number of therapists and sports medicine physicians have adopted an accelerated form of ACL rehabilitation. This new ACL rehab features early weightbearing and knee extension. Following surgery, place the athlete in a post-op brace.

The athlete can begin walking on the knee as soon as pain and swelling allows. This innovative approach is credited with dramatically decreasing the incidence of stiffness. The key to this accelerated program is regaining a full range of motion of the knee as soon as possible. Therefore, patients and players are able to fully extend and bend their knees to 90 degrees after the first week. As soon as pain allows, early weightbearing prevents wasting or atrophy of the leg muscles. This allows for a more functional performance of day-to-day activities. When the range of motion and normal function return to normal, exercises that emphasize strength, power and endurance are started.

Often, patients may begin straight-line running by three months after their surgery.  Usually agility-type exercises can be begin between five and nine months. Therefore, many of these elite athletes and weekend warriors may be ready sooner to perform sports-specific activities.  It is critical to the athlete and patient to understand that the “new” ligament is being remodeled by the body. It does not reach its full strength until six months to a year. Sports-specific activities that involve running, jumping and cutting are very hazardous for this first six-month period. Often during this period of time, athletes will wear ACL braces to help protect the knee ACL graft as the athlete returns to normal play.

Rehab or Physical Therapy – ACL Tears

ACL treatment for ACL tears varies depending on the severity of the injury. Non-surgical treatments such as physical therapy and rehabilitation are often recommended for partial ACL tears or for those leading a less active lifestyle. These treatments aim to alleviate ACL pain symptoms, strengthen the surrounding muscles, and improve stability through targeted exercises.

In more severe cases, surgical intervention may be necessary. This is often the case for athletes or individuals with complete ACL tears. Post-operative care and rehabilitation are crucial for a successful recovery. Adhering to the rehabilitation plan is essential to prevent complications, optimize healing, and ensure a return to normal activities.

The exact time to recover from this injury varies from person to person. Persons with limited mobility and some older individuals may not even need the surgery. Upon completion of a comprehensive ACL rehabilitation program, they may resume low-demand activities. For those patients who do require surgery, the exact time to return to their specific sports may vary. Many therapists and physicians disagree about the exact length of time that ACL rehab encompasses.  I have seen that many athletes find that their knee continues to require extra rehab for over a year and that the knee continues to improve for up to two years after one of these complex surgeries. With early, prompt diagnosis, modern surgery and an aggressive rehab program, many people do return to their sport and enjoy an active lifestyle.  To schedule physical therapy at one of the 13 JOI Rehab Centers, please call 904-858-7045. 

If you want to see a video about a Torn ACL, go to: ACL

Related Articles: Understanding ACL Reconstruction Surgery, Knee Pain and Total Knee Replacement FAQ

JOI and JOI Rehab

JOI Physicians continue to offer online new patient appointments. Our JOI Physicians are Northeast Florida’s most respected orthopedic practice.  To make an appointment by calling (904) JOI-2000 or schedule online. This is a new option to make it more convenient to make new patient appointments.  Follow the link below to select your JOI MD and schedule online.

By: Drew Heideman, PT, ATC