Anterior Cruciate Ligament Tear

What is Anterior Cruciate Ligament Tear

Ligaments are strong bands of tissue that connect bones to each other. The anterior cruciate ligament (ACL) connects your shin bone to your thigh bone. A tear in this ligament can cause pain and make it hard for you to put weight on your leg (use your leg to support your body weight).

There are three types of ACL injuries:

• Grade 1. In this type, the ligament is stretched.
• Grade 2. In this type, the ligament is partially torn.
• Grade 3. In this type, the ligament is completely torn.

What are the causes?

This condition happens when too much pressure is put on the ACL. It may happen if:

• You twist your knee, especially with your foot planted.
• You make a quick change in direction (cut and pivot).
• You slow down quickly while running.
• You land a jump without bending your knee.
• You forcefully straighten your knee more than normal (hyperextendyour knee).
• You are hit in the knee.
• You hit your knee on the ground.

What increases the risk?

This condition is more likely to develop in:

• Women.
• People who play sports that involve jumping or changing directions often. These include:
  • Football.
  • Basketball.
  • Volleyball.
  • Soccer.
  • Skiing.
  • Hockey.
  • Gymnastics

What are the signs or symptoms?

Symptoms of this condition include:

• A popping sound at the time of injury.
• A feeling that your knee is bending abnormally at the time of injury.
• Pain.
• Swelling.
• Tenderness.
• Instability when you try to put weight on your injured leg.
• Inability to move your knee as far as normal.
• Difficulty walking.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Tests, such as:
  • An X-ray. This may be done to check for bone injuries.
  • MRI. This may be done to see if the tear is partial or complete and to check for additional injuries.

During your physical exam, your provider will test your knee to see if it moves more than it should (laxity).

How is this treated?

This condition may be treated with:

• Resting your knee.
• Avoiding activities that cause pain, instability, or swelling.
• Raising (elevating) your knee while resting.
• Keeping weight off your leg until pain and swelling improve. You may need to use crutches or a walker.
• Icing your knee.
• Taking medicine to reduce pain and swelling.
• Wearing a knee brace.
• Doing range-of-motion, strengthening, and stretching exercises (physical therapy).
• Surgery. This may be needed if you are very active and have a complete tear.

Follow these instructions at home:

If you have a brace:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your toes tingle, become numb, or turn cold and blue.
• Do notlet your brace get wet if it is not waterproof.
• Keep the brace clean.

Managing pain, stiffness, and swelling

• If directed, put ice on your knee:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your foot often to avoid stiffness and to lessen swelling.
• Elevate your knee above the level of your heart while you are sitting or lying down.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Ask your health care provider when it is safe to drive if you have a brace on your leg.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do notuse the injured limb to support your body weight until your health care provider says that you can. Use crutches or a walker as told by your health care provider.
• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Make sure to use equipment that fits you.
• If you wear cleats, make sure they are appropriate for your playing surface.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.

Contact a health care provider if:

• Your symptoms are not improving.
• Your symptoms are getting worse.

Anterior Cruciate Ligament Tear Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain and stiffness.

Exercise A: Knee flexion, active

1. Lie on your back with both knees straight. If this causes back discomfort, bend your healthy knee so your foot is flat on the floor.
2. Slowly slide your left / right heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.
3. Hold for __________ seconds.
4. Slowly slide your left / right heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Knee extension, sitting

1. Sit with your left / right heel propped up on a chair, a coffee table, or a footstool. Do nothave anything under your knee to support it.
2. Allow your leg muscles to relax, letting gravity straighten out your knee. You should feel a stretch behind your left / right knee.
3. If told by your health care provider, deepen the stretch by placing a __________ lb weight on your thigh, just above your kneecap.
4. Hold this position for __________ seconds.
5. Rest your left / right foot on the floor and allow your muscles to relax after each repetition.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Hamstring curls

If told by your health care provider, do this exercise while wearing ankle weights. Begin with __________ weights. Then increase the weight by 1 lb (0.5 kg) increments. Do notwear ankle weights that are more than __________.

1. Lie on your abdomen with your legs straight. You can put a towel above your left / right knee for comfort.
2. Bend your left / right knee up to __________ degrees. Keep your hips flat.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Straight leg raises (

quadriceps)

1. Lie on your back with your left / right leg extended and your other knee bent.
2. Tense the muscles in the front of your left / right thigh. You should see your kneecap slide up or see increased dimpling just above your knee.
3. Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor.
4. Hold for __________ seconds.
5. Keep these muscles tense as you lower your leg.
6. Relax your muscles slowly and completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Bridge (

hip extensors)

1. Lie on your back on a firm surface with your knees bent and your feet flat on the floor.
2. Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs.
   • Do notarch your back.
   • You should feel the muscles working in your buttocks and the back of your thighs. If you do not feel a stretch in those muscles, slide your feet 1–2 inches (2.5–5 cm) farther away from your buttocks.
3. Hold this position for __________ seconds.
4. Slowly lower your hips to the starting position.
5. Let your buttocks muscles relax completely between repetitions.
6. If this exercise is too easy, try doing it with your arms crossed over your chest.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Straight leg raises (

hip abductors)

1. Lie on your side with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your bottom knee to help you balance.
2. Lift your top leg 4–6 inches (10–15 cm) while keeping your toes pointed straight ahead.
3. Hold this position for __________ seconds.
4. Slowly lower your leg to the starting position.
5. Let your muscles relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.