Pathology
An anterior cruciate ligament (ACL) rupture is an injury to one of the main stabilizing ligaments of the knee. The ACL connects the thigh bone (femur) to the shin bone (tibia) and helps control forward movement and rotation of the knee.
This injury commonly occurs during sports that involve sudden stops, changes in direction, pivoting, or landing from a jump (e.g. football, skiing, basketball). It may happen with or without contact.
Typical symptoms include a sudden “popping” sensation, pain, rapid swelling of the knee, and a feeling of instability or the knee “giving way.”
Examination
The diagnosis is usually suspected based on clinical examination, including specific stability tests of the knee.
An MRI scan is typically performed to confirm the diagnosis and to assess associated injuries such as meniscal tears or cartilage damage. X-rays may also be taken to rule out fractures.
Treatment
Non-surgical treatment
In selected cases (e.g. low activity level or stable knee), treatment may be non-surgical. This includes physiotherapy focused on strengthening the muscles around the knee, improving stability, and restoring range of motion. A knee brace may sometimes be used.
Surgical treatment
In active patients or in cases of significant instability, surgical reconstruction of the ACL is often recommended. The torn ligament cannot usually be repaired directly and is therefore replaced with a graft (typically a tendon taken from the patient, such as the hamstring or patellar tendon).
The surgery is usually performed arthroscopically. After the procedure, a structured rehabilitation program is essential.
Recovery
Recovery after an ACL injury takes time and requires commitment to rehabilitation. Return to sports typically occurs after 6 to 12 months, depending on progress.
Even after treatment, some patients may experience occasional discomfort or a feeling of instability. A gradual return to activity and proper muscle strengthening are key to a successful outcome.
