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What is an ACL Injury? A torn ACL is an injury or tear to the anterior cruciate ligament (ACL).

The ACL is one of the four main stabilising ligaments of the knee, the others being the Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). The ACL attaches to the knee end of the Femur (thigh bone), at the back of the joint and passes down through the knee joint to the front of the flat upper surface of the Tibia (shin bone). It passes across the knee joint in a diagonal direction and with the PCL passing in the opposite direction, forms a cross shape, hence the name cruciate ligaments.

The role of the Anterior Cruciate Ligament is to prevent forward movement of the Tibia from underneath the femur. The Posterior Cruciate Ligament prevents movement of the Tibia in a backwards direction. Together these two ligaments are vitally important to the stability of the knee joint, especially in contact sports and those that involve fast changes in direction and twisting and pivoting movements. Therefore a torn ACL or ACL injury has serious implications for the stability and function of the knee joint.

How Does a Torn ACL or ACL Tear Occur? A torn ACL usually occurs through a twisting force being applied to the knee whilst the foot is firmly planted on the ground or upon landing. A torn ACL can also result from a direct blow to the knee, usually the outside, as may occur during a football or rugby tackle. This injury is sometimes seen in combination with a medial meniscus tear and MCL injury, which is termed ODonohues triad.

Anterior cruciate ligament injuries are more frequent in females with between 2 and 8 times more females suffering a rupture than males, depending on the sport involved and the literature reviewed. The reason for this is as yet unknown, however areas of current research include anatomical differences; the effect of oestrogen on the ACL and differences in muscle balance in males and females. Treatment for an Anterior Cruciate Rupture

What can the athlete do? Immediately stop play or competition. Apply RICE (Rest, Ice, Compression, Elevation) to the knee immediately. Seek medical attention as soon as possible.

What can a Professional do? A Doctor or Sports Injury Professional can assess the knee joint to confirm a torn ACL or ACL tear Diagnose any additional injuries If unsure you may be sent for an MRI scan or X-ray Refer for ACL Surgery if required Provide a pre-surgery rehabilitation program in order to strengthen the knee and reduce the swelling in preparation for surgery. This will help produce the best results following surgery. What Does ACL Surgery Involve? Surgery involves either repairing or reconstructing the torn ACL. With a repair, the exisiting damaged ligament is sutured (stitched) if the tear is in the middle. If the ligament has detached from the bone (avulsed) then the bony fragment is reattached. Surgical reconstruction of the torn ACL is performed using either an extraarticular technique (taking a structure that lies outside the joint capsule such as a portion of the hamstring tendon) or an intraarticular technique (using a structure from within the knee such as part of the patellar tendon) which will replace the anterior cruciate ligament. When is ACL Surgery Required? Surgery is performed more often than not following Anterior Cruciate ligament tears. The decision on whether to operate is based on a number of factors, including the athletes age; lifestyle; sporting involvement; occupation; degree of knee instability and any other associated injuries. Older people who are less active and perhaps injured their ACL following a fall as opposed to during sport would be unlikely to undergo surgery. A younger, fit person who regularly plays sport and would be more likely to adhere to a complex rehabilitation program is very likely to be offered surgery How long will the athlete with a torn ACL be out of action? This largely depends on your surgeon or physiotherapists approach to rehabilitation. Some therapists advocate an accelerated rehabilitation programme returning the athlete to full competition within 6 months, others prefer a 9 month rehabilitation period. More information on rehabilitation of an acl knee injury can be see on our anterior cruciate ligament rehabilitation page.