A sprain is a joint injury that causes a stretch or a tear in a ligament. Ligaments are strong bands of tissue that connect one bone to another. The anterior cruciate ligament (ACL) is one of the major ligaments in the middle of the knee. It connects the thigh bone (femur) to the shin bone (tibia). This ligament, along with the posterior cruciate ligament, helps keep the knee stable and protects the femur from sliding or turning on the tibia.
Sprains are graded I, II, or III depending on their severity:
The anterior cruciate ligament is frequently injured in forced twisting motions of the knee. It may also become injured when the knee is straightened further than it normally can straighten (hyperextended). It sometimes occurs when the thigh bone is forcefully pushed across the shin bone, such as with a sudden stop while you are running or a sudden transfer of weight while you are skiing.
There is usually a loud, painful pop when the joint is first injured. This is often followed by a lot of swelling of the knee within the first several hours after the injury. This swelling is called an effusion and is made up of blood in the knee joint.
If you have torn your anterior cruciate ligament in an injury that occurred months or years ago and you haven't had reconstructive surgery, you may have the feeling that the knee is giving way during twisting or pivoting movements.
Your health care provider will examine your knee and may find that your knee has become loose. If you have swelling in the joint, he or she may decide to remove the blood in your knee with a needle and syringe. You may need x-rays to see if there is an injury to the bones in your knee. An MRI (magnetic resonance imaging) scan may also be done and should clearly show the condition of your ACL (as well as that of other ligaments and cartilage).
Treatment includes the following:
Your provider may recommend that you:
For complete tears, you and your health care provider will decide if you should have intense rehabilitation or if you should have surgery followed by rehabilitation. The torn anterior cruciate ligament cannot be sewn back together. The ligament must be reconstructed by taking ligaments or tendons from another part of your leg and connecting them to the tibia and femur.
You may consider having reconstructive ACL surgery if:
You may consider not having the surgery if:
If a growing child tears an ACL, the health care provider may recommend that surgery be postponed until the child has stopped growing.
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity will be determined by how soon your knee recovers, not by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
If you feel that your knee is giving way or if you develop pain or have swelling in your knee, you should see your health care provider. If you've had surgery, be sure that your provider has told you that you can return to your sport.
Unfortunately, most injuries to the anterior cruciate ligament occur during accidents that are not preventable. However, you may be able to avoid these injuries by having strong thigh and hamstring muscles and maintaining a good leg stretching routine. In activities such as skiing, make sure your ski bindings are set correctly by a trained professional so that your skis will release when you fall.