The anterior cruciate ligament (ACL) joins the thigh bone to the shin bone in the centre of the knee and stops the lower leg from sliding forwards. A torn ACL is one of the most common serious sports injuries of the knee. It usually tears when you stop suddenly, change direction or land badly, often without contact from another person. It is more common in women and in sports such as football, basketball, skiing and handball.
Symptoms
- A pop in the knee at the moment of injury.
- Rapid swelling in the first hours.
- Severe pain at first, and difficulty putting weight on the leg.
- A feeling that the knee gives way or slips when you twist.
- You can’t carry on playing.
- Pain on the inner or outer side, if the meniscus is damaged too.
After a few weeks the pain and swelling ease, and the knee may seem fine when you walk. The instability stays, however, and shows up when you twist, go down stairs or play sport. Every new episode of giving way can damage the meniscus or the cartilage. That is why the decision about surgery shouldn’t be put off for too long.
Why it happens
- Stopping suddenly and changing direction.
- Landing from a jump with the knee collapsing inwards.
- Twisting the body with the foot planted on the ground.
- A blow to the side of the knee.
- Fatigue and poor control of the thigh and buttock muscles when jumping.
The ACL often tears together with the meniscus or the ligament on the inner side of the knee. That is why after such an injury you need to see an orthopaedic doctor and usually have an MRI. Women have a higher risk, partly because of the way they land. Exercises for landing and knee control lower the risk in athletes.
How we treat it
Bring your MRI and, after surgery, the discharge summary. Kaloyan tests how stable the knee is, and the decision about surgery is made with an orthopaedic doctor. Before surgery, pre-operative rehabilitation reduces the swelling, gets the knee straightening fully again and strengthens the thigh. A knee that goes into surgery without swelling and with full movement usually recovers more smoothly.
After surgery, post-operative rehabilitation goes through stages: movement and walking without crutches, then strength and balance, and finally running, jumping and changing direction. Kaloyan follows your surgeon’s protocol, and before each new stage he checks the strength and control of your leg with tests: single-leg hop tests and measuring the strength of the front thigh muscle (dynamometry), to compare your two legs. Most people return to their everyday activities within a few weeks, and the last months are for sport. People usually return to sport after 6 to 9 months, some of them later. For less active people, treatment without surgery is sometimes chosen, with exercises for strength and stability, and Kaloyan guides that too. He also works with people whose surgery was years ago and whose knee still isn’t what it was.
What you can do yourself
- Straight after the injury: rest, cold for a short time, your leg raised and an examination by an orthopaedic doctor.
- Don’t go back to sport while the knee gives way.
- Don’t ski or play football, basketball or tennis until Kaloyan and your surgeon have cleared you.
- If you are waiting for surgery, do the exercises you were given every day.
- After surgery, keep the swelling under control: leg raised and cold, as your surgeon has told you.
When to see a doctor first
See a doctor or an orthopaedist first if:
- you have just had an injury with a pop and rapid swelling;
- you can’t put weight on your leg;
- the knee is locked or looks deformed;
- your lower leg is swollen, warm and painful, especially after surgery.
