ACL Tear: Symptoms, Causes, Treatment & Recovery Time

An ACL tear refers to a rupture or sprain of the anterior cruciate ligament (ACL). This pivotal ligament connects the femur (thigh bone) to the tibia (shinbone) and maintains knee stability.

The tear primarily happens during sports activities (badminton, football, etc.) or movements that involve sudden stops or pivoting. It can either be partial, involving only some fibres, or complete, involving the ligament being entirely severed.

It can be classified into several types based on the severity and nature of the injury. Here are the main categories:

1. ACL Sprains: The injuries where the anterior cruciate ligament (ACL) in the knee is stretched or torn. They are divided into different grades based on the severity:

2. ACL Avulsion Fracture: It is more common in children and can result from direct trauma to the ligament attached to the tibia (shinbone).

3. ACL Deficient Knee: This condition is prevalent when the ACL is absent, leading to knee instability. It may also cause additional injuries, such as meniscus tears and cartilage damage.

4. Complex and Multi-Ligament Knee Injuries: These involve injuries to the ACL along with other knee structures such as the meniscus, collateral ligaments, or articular cartilage. 

It typically presents with several distinct indications. These signs can differ based on the extent of the injury. Here is the common list:

• Popping Sound: Hearing a loud pop at the time of injury

• Severe Pain: Immediate and intense discomfort, often making it difficult to continue any physical activity

• Inflammation: Rapid swelling due to bleeding within the joint

• Instability: Lack of composure in the knee during weight-bearing activities

• Loss of Range of Motion: Significant reduction in mobility leading to difficulty in bending the knee

• Inability to Bear Weight: Difficulty in putting body weight on the affected leg

The primary reasons for an ACL tear are typically related to activities that place excessive stress on the knee joint. Here are some of the activities that can cause damage:

1. Changes in Direction: Sports that involve quick pivoting, such as football or basketball

2. Impact to the Knee: A fatal blow to the knee which induces trauma (E.g., a tackle while playing soccer)

3. Accidental Deceleration: Abruptly slowing down while running can hyperextend the knee

4. Overextension of the Knee: Extending the knee joint beyond its normal range of motion 

Risk Factors of ACL Tear

Active participation in sports can alleviate the risk of tearing the ligament. Other common factors include:

1. Gender: Women are at a higher risk of ACL tears compared to males. This is attributed to anatomical differences, hormonal influences, and variations in muscle strength.

2. Age: It is quite common for individuals between 15 and 45. This is primarily due to extended levels of sports participation and physical activity.

3. Previous ACL Injury: Individuals with a history of torn ACL are prone to re-injury. 

4. Genetic Factors: A family history of ACL injuries can increase the risk, suggesting a genetic tendency to ligament injuries.

5. Weak Core Muscles: Poor trunk and hip stability can increase knee strain.

Preventing ACL tears involves strength training, proper technique, and physical conditioning. Here are some effective strategies:

1. Year-Round Exercise: Maintaining a consistent workout routine to keep the muscles around the knees strong and flexible. Regular physical activity helps improve balance and body awareness.

2. Proper Technique: Practising safe landing techniques by bending at the knees and hips to align them with the feet. This reduces the stress on the ACL during activities like jumping and pivoting.

3. Avoiding Exercising When Tired: Fatigue can result in incorrect form while performing the activity. Ensuring adequate rest is extremely important for muscle recovery.

4. Strengthen Key Muscle Groups: Focusing on strengthening the hamstrings and quadriceps, which work together to stabilise the knee. 

5. Using Proper Footwear: Wearing well-fitted shoes that provide good support and traction. Proper footwear can prevent slips and awkward movements.

The typical diagnosis of an ACL tear requires a combination of the following methods. Here is the list:

1. Patient history and physical examination:

• The healthcare provider will ask about the mechanism of injury and symptoms, such as a popping sound, swelling, instability, etc.

• Physical tests like the Anterior drawer, pivot shift, and Lachman tests are performed to assess ACL integrity.

2. Imaging tests:

• X-rays are usually done first to rule out any fractures.

• Magnetic Resonance Imaging is required to visualise the ACL and surrounding structures.

• Ultrasound can also evaluate ACL tears, especially when MRI is unavailable. It looks for signs like an abnormal ACL orientation or discontinuity of the ligament fibres.

3. Arthroscopy:

• This surgical procedure allows a direct view of the ACL and knee joint through small incisions.

• It is considered the definitive method to diagnose ACL tears, especially when physical exam and imaging findings are inconclusive.

• They mainly performed at the same time as ACL reconstruction surgery.

How to prepare for a doctor consultation?

Preparing for a consultation with a doctor is crucial to get the most out of the visit. Here are some effective strategies:

1. Collecting and documenting all relevant medical history, previous test results, and any recent medical reports. This helps the doctor understand the patient's medical background and current condition.

2. Listing down all current medications, including prescriptions and supplements. The list should also contain the dosages and frequency for a comprehensive understanding.

3. Noting down the symptoms and their frequency. It is important to help the doctor in making an accurate diagnosis.

Questions to Ask the Doctor

When consulting a doctor, it is important to ask comprehensive questions to understand the condition and available treatment options. Here are some examples:

• What grade is my ACL tear?

• What are the different treatment options available?

• How is the surgery performed, and what can I expect during the procedure?

• What are the risks and potential complications of the surgery?

• How long will the recovery process take?

• What are the chances of re-injury or long-term complications?

"During my practice in India, I've often encountered patients with ACL tears, particularly among athletes and young individuals. One memorable case involved a young cricketer whose career was on the line.

Through a meticulous diagnostic process and a successful arthroscopic reconstruction, we got him back on the field within six months, fully restored and performing at his peak.”

- Dr Prince Gupta
Orthopaedics

Treatment options for an ACL tear can be broadly categorised into non-surgical and surgical approaches. The choice of modality varies according to the severity of the tear, activity level of the patient, and their overall health.

Non-Surgical Treatment

1. RICE Method

• Rest: Avoid activities that cause knee pain, such as running or walking for long periods.

• Ice: Applying ice packs to the knee several times a day for 10-20 minutes

• Compression: Using a tight, elastic bandage around the knee

• Elevation: Keeping the knee elevated above the waist 

2. Physical Therapy: Strengthening ACL tear exercises for the muscles around the knee, particularly the hamstrings.

3. Knee Bracing: Wearing a knee brace to provide stability and restrict side-to-side movement.

Surgical Treatment

1. ACL Reconstruction: The damaged ACL is replaced with a tissue graft. It can be made from the patient's tendons (autograft) or a donor (allograft). Common sources include:

• Patellar tendon

• Hamstring tendon

• Quadriceps tendon

2. Primary Repair: This method involves stitching the torn ACL back to its original position. It is typically used for specific types of tears, such as avulsion injuries, where the ligament is torn from the bone.

ACL Tear Surgery Cost

Total cost can differ significantly depending on several factors, such as the type of treatment required, the location, and the healthcare provider. The average cost of ACL reconstruction surgery in India is around ₹1,30,000.

Delaying treatment for an ACL tear can lead to several significant risks, particularly for young athletes and active individuals. These include:

1. Risk of Meniscal Tears: Postponing ACL reconstruction increases the risk of developing meniscal tears.

2. Further Knee Damage: The instability caused by the condition can lead to additional injuries to the knee. These include damage to the articular cartilage and other ligaments. 

3. Reduced Treatment Options: A delay in surgery can limit the effectiveness of treatment options. For example, a meniscal tear that could have been repaired early might become irreparable.

4. Increased Recovery Time: Lack of promptness in treatment can result in a longer and more complicated recovery process. Early intervention typically leads to better outcomes and a quicker return to normal activities.

5. Extended Instability: Without timely medical intervention, the knee may remain unstable, leading to ongoing issues with balance and mobility. 

When to call a doctor?

Early diagnosis and treatment can help with faster ACL tear recovery. It is important to seek medical attention in the below-mentioned cases:

• Severe Pain or Swelling

• Inability to Bear Weight

• Instability 

• Popping Sound at the Time of Injury

• Loss of Sensation or Coldness in the Foot

A balanced diet can help with faster ACL tear recovery. Here are some recommendations:

1. Protein: It is essential for repairing and rebuilding the torn ACL ligament. Good sources include:

• Lean meats like chicken, turkey, fish

• Eggs

• Dairy products like milk, yoghourt, cheese

• Beans, lentils, tofu

2. Fruits and Vegetables: These provide antioxidants, vitamins and minerals to support healing and reduce inflammation. Some options include:

• Berries

• Citrus fruits

• Leafy greens

• Bell peppers

3. Whole Grains: Necessary for the requirement of complex carbohydrates for energy as well as fibre, vitamins and minerals. Examples include:

• Brown rice

• Quinoa

• Oats

• Whole wheat bread/pasta

Are you also considering resuming your sporting activities after an ACL tear? If yes, you must understand the symptoms and treatment options to manage the condition and recover effectively.

To fix an anterior cruciate ligament tear, consulting an experienced healthcare professional like HexaHealth can go a long way for a proper diagnosis. Our team can significantly improve your recovery and reduce the risk of long-term complications with expert guidance and support.