Anterior Cruciate Ligament (ACL) Tear

The knee joint has four main ligaments whose role is to maintain and stabilize the femur and tibia together. The anterior cruciate ligament is the one most frequently completely injured in the knee. This tear is one of the most common sports injuries, especially among young people. Depending on the severity of the injury, it may also be associated with damage to other structures, such as a meniscus tear or medial collateral ligament injury.

 

What population is affected by this injury?

Anyone can suffer an anterior cruciate ligament tear, but prevalence is higher among teenagers and young adults, with women being affected in greater proportion. Athletes are also more commonly affected by this injury, especially those who practise contact sports or sports that involve rapid changes of direction, such as soccer, football, skiing, basketball, etc.

 

How does it happen?

Several injury mechanisms can lead to an ACL tear. These include twisting of the knee while bearing weight, the knee moving excessively inward — a valgus movement — or hyperextension. It may or may not be associated with contact or a fall.

 

What are the symptoms?

When the tear is complete, it generally causes a characteristic “pop” sound. It is associated with intense pain, an inability to put weight on the knee, difficulty moving it, and swelling that appears quickly. Classic inflammatory signs such as redness and warmth may also be observed.

 

What is the treatment?

If you suspect this type of injury, it is recommended that you consult your physician or physiotherapist quickly. When an ACL tear is suspected, an MRI — magnetic resonance imaging — is generally required to confirm the diagnosis. This imaging test helps determine the severity of the tear as well as the extent of the structures affected. Your physician may also prescribe an X-ray to ensure there is no fracture.

In the case of a complete tear, you will be referred to an orthopedist to determine whether ligament reconstruction surgery is appropriate. This surgery is not essential for recovery in all cases; it depends on your symptoms and your needs. If you choose to undergo surgery, you will need to consult a physiotherapist beforehand to complete a strengthening program in preparation for the procedure. Rehabilitation will also involve postoperative physiotherapy follow-up.

If the tear is partial or if surgery is not being considered, it will be important to consult a physiotherapist to support you through rehabilitation. Treatment is divided into three phases:

1. The acute phase: Immediately after the injury, it will be important to rest. You may need to use crutches if bearing weight is painful. If the knee is swollen, you can use a compression bandage and elevate the knee by placing the leg on a stack of pillows. In case of pain, you can apply ice or consult your pharmacist to obtain the appropriate medication. It is also recommended not to immobilize the knee, as gentle movement while respecting symptoms will help prevent joint stiffness.
2. The subacute phase: This is a crucial phase of rehabilitation and involves a structured exercise program to restore strength, mobility, and proprioception in order to prepare for a return to sport and prevent recurrence of the injury.
3. Return-to-physical-activity phase: For a successful return to activity, the process must be gradual, well organized, and guided by symptom tolerance. At this stage, your physiotherapist may use functional tests to measure your physical abilities, such as strength, jumping, agility tests, etc.

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