Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
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Collateral Ligaments
These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement. |
Cruciate Ligaments
These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee. The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee. |
About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments. Injured ligaments are considered "sprains" and are graded on a severity scale.
Grade 1 Sprains
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains
A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate are rare. Most ACL injuries are complete or near complete tears.
Grade 1 Sprains
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains
A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate are rare. Most ACL injuries are complete or near complete tears.
Cause
The anterior cruciate ligament can be injured in several ways:
The anterior cruciate ligament can be injured in several ways:
- Changing direction rapidly
- Stopping suddenly
- Slowing down while running
- Landing from a jump incorrectly
- Direct contact or collision, such as a football tackle
Symptoms
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:
- Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
- Loss of full range of motion
- Tenderness along the joint line
- Discomfort while walking
Doctor Examination
Physical Examination and Patient History
During your first visit, your doctor will talk to you about your symptoms and medical history.
During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
X-rays
Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a
broken bone.
Magnetic resonance imaging (MRI) scan
This study creates better images of soft tissues like the anterior cruciate ligament. While an MRI is usually not required to make the
diagnosis of a torn ACL, it can frequently be useful in confirming the diagnosis and determining if any other structures are
damaged (such as the meniscus).
Physical Examination and Patient History
During your first visit, your doctor will talk to you about your symptoms and medical history.
During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
X-rays
Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a
broken bone.
Magnetic resonance imaging (MRI) scan
This study creates better images of soft tissues like the anterior cruciate ligament. While an MRI is usually not required to make the
diagnosis of a torn ACL, it can frequently be useful in confirming the diagnosis and determining if any other structures are
damaged (such as the meniscus).
Treatment
Treatment for an ACL tear will vary depending upon the patient's individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very
low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.
Bracing
Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy
As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and
strengthen the leg muscles that support it.
Surgical Treatment
Rebuilding the ligament
Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament
must be reconstructed. Your surgeon will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new
ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and
the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which
runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.
There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon
to help determine which is best for you.
Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.
Procedure
Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is
less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker
recovery times.
Unless ACL reconstruction is treatment for a combined ligament injury, it is usually not done right away. This delay gives the inflammation a chance to resolve, and allows a return of motion before surgery. Performing an ACL reconstruction too early greatly increases the risk of arthrofibrosis, or scar forming in the joint, which would risk a loss of knee motion.
Treatment for an ACL tear will vary depending upon the patient's individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very
low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.
Bracing
Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy
As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and
strengthen the leg muscles that support it.
Surgical Treatment
Rebuilding the ligament
Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament
must be reconstructed. Your surgeon will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new
ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and
the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which
runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.
There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon
to help determine which is best for you.
Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.
Procedure
Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is
less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker
recovery times.
Unless ACL reconstruction is treatment for a combined ligament injury, it is usually not done right away. This delay gives the inflammation a chance to resolve, and allows a return of motion before surgery. Performing an ACL reconstruction too early greatly increases the risk of arthrofibrosis, or scar forming in the joint, which would risk a loss of knee motion.
Rehabilitation
Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.
If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete's sport.
To learn more about the full value of ACL surgery: Getting Back in the Game: Understanding the Impacts of Treatment Options for ACL Tears
Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.
If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete's sport.
To learn more about the full value of ACL surgery: Getting Back in the Game: Understanding the Impacts of Treatment Options for ACL Tears
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.
