Anterior Cruciate Ligament (ACL) Injury

What is an ACL injury?

The ACL is a strong band of fibrous tissue within the knee joint that attaches from the bottom of the Femur (thigh bone) to the top of the Tibia (shin bone). Its role is to provide stability to the joint, specifically by preventing the Tibia from being pulled too far forward.

As with all ligaments if they are stressed or pulled too far beyond their capacity, they are at risk of injury. This can range from a small, partial tear up to a larger partial tear and most severely a complete tear or rupture of the ligament.

It is common with ACL injuries, especially more severe ones, for other structures of the knee to be affected. The Medial Collateral Ligament (MCL) and Medial Meniscus being the most common.

How do they happen?

ACL injuries happen most frequently within sport but can occur during other exercise. Taking a direct hit to your knee, especially from the side, can lead to ACL injury, however, most injuries are due to non-contact events.

When the knee is rotated and bent in a certain way and then put under strain, such as when jumping, changing direction or stopping quickly (or combination), the ACL is at most risk of injury. This is why they occur more often in sports such as football, rugby, basketball and skiing.

How do I know if I have injured my ACL?

At the time of the injury and shortly after you may experience the following signs or symptoms:

A sudden ‘pop or crack’ sensation in the knee.

Sharp pain and difficulty putting weight through your leg with an inability to continue your activity/exercise.

A feeling of instability at the knee.

Swelling around the knee and decreased range of motion.

What to do if you think you have injured your ACL?

Think ‘PEACE’ & ‘LOVE.
This acronym can be used for all acute injuries, not just knees.

(P)rotect – deload or restrict movement and use of the knee for 2-3 days to minimise further aggravation. This may include using crutches or knee brace if walking is too difficult.

(E)levate – Aim to keep your knee elevated when resting to reduce local swelling.

(A)void anti-inflammatories – the inflammation process is important for tissues to heal so we don’t want to limit this. Use pain relief such as paracetamol to help with pain.

(C)ompress – use a bandage or brace to help limit local swelling around the knee.

(E)ducation – understand your injury and how best to move forward by seeking professional guidance and assessment. If an ACL injury is thought to have occurred a scan may be organised to confirm.

Recent research has shown that applying ice after an injury can reduce the healing properties that you get from inflammation so avoid icing the knee, instead use the above methods to help control swelling.

‘LOVE’ stands for Load, Optimism, Vascularisation and Exercise and is used for management of your knee injury after the first 2-3 days. It encourages gentle movement and use of your knee as much as your pain and symptoms allow.

Working with a physio will help to guide you through this stage confidently and progress into the rehab of your knee injury.

If I have damaged or ruptured my ACL do I need surgery to fix it?

The short answer is no however, as with all things, it is slightly more complicated than that.

Previously, more substantial tears or ruptured ACL’s have mostly been managed by having surgery to repair the damage. It was thought that the ACL did not get a good enough blood supply to promote the healing needed for the ACL to repair itself. More recent studies have now shown that the ACL is able to spontaneously heal, even after a complete rupture! Meaning that surgery is not necessarily required to fix it.

We also know that managing an ACL injury conservatively (without surgery) can work for certain people. By rehabbing and strengthening up around the knee we can create the stability needed to manage daily activities and tasks without our ACL being fully recovered.

How do I decide whether to have surgery or not?

This is where we have to understand that everyone is different and your body and needs are individual to you. So, what works for you may not work for someone else and vice-versa.

Discussion around this with a professional is important to help you decide what management will be best for you. This should take factors such as lifestyle, your goals, return to sport, your understanding and preferences into account.

What will rehab for my ACL injury look like?

Here at JLPhysioFit we implement a 6-stage rehab model taking you right from initial injury through to return to play

Phase 1- Injury recovery and readiness for surgery (if you have decided to have surgery).

Phase 2- Recovery from surgery (again, if surgery is carried out).

Phase 3- Strength and Neuromuscular Control

Phase 4- Running, Agility and Landings

Phase 5- Return to Sport

Phase 6- Prevention of re-injury

After your injury it is very important to start your rehab as soon as able. If you have chosen to have surgery it has been shown that people who went through knee focused rehab before surgery had better outcomes than those who didn’t. So either way, getting going with the rehab is crucial to a good outcome.

How long does my rehab take? And when can I go back to playing sport?

Current research suggests that returning to sports should not be done before 9 months post-surgery to reduce the risk of re-injury. However, your rehab should be individualised to you, this means progressing based on performance not time.

In our rehab model we use a range of specific outcome measures to determine whether you are ready to move on to the next phase of the process. These are carefully measured and monitored regularly and include both physical and psychological assessment.

How do I get started?

If you are ready to book in then you can either phone the main desk on 0191 814 9717, or use our easy online booking system by clicking here and selecting the ‘Physiotherapy Assessment/First Appointment’ option at a day and time that suits you. You will usually be offered an appointment within 48 hours.

Like to speak to someone first?

No problem, please call the main desk and if needed we can have a physio call you back to discuss your specific situation.