The anterior cruciate ligament (ACL) originates on the medial tibial articular surface and travels posteriorly where it inserts on the lateral femoral condyle and functions to provide rotational stability and resistance of anterior tibial translation, varus and valgus stress.
ACL injuries compromise 40-50% of all ligamentous knee injuries in sports and occur more commonly in sports such as skiing, soccer, basketball and football. Most ACL injuries occur due to noncontact mechanisms, primarily during landing, pivoting or deceleration.
Signs and symptoms
popping sensation at the time of injury
large amount of swelling within 3-12 hours after the injury
loss of motion
feeling of instability
Physical examination by a skilled provider and imaging studies such as an MRI are used to diagnose ACL injuries.
Treatment of ACL injuries varies on the patient activity level and degree of tear.
In young active athletes who wish to continue playing high level sports that require cutting, pivoting and jumping movements, reconstruction of the ACL may be recommended; however is not required. In those who wish to avoid surgery, several months of physical therapy is often recommended to strengthen the knee and prevent further injury. Additionally, patients often benefit from custom fit ACL braces to stabilize the knee during sporting activities. Older less active individuals can be treated non-operatively with physical therapy and bracing as well.
If operative management is recommended, pre-operative physical therapy is highly recommended.
Treatment of ACL injuries