ACL Tears

Few injuries are as infamous as the dreaded ACL tear. The boogeyman of the professional athlete and average Joe alike, ACL tears haunt our fitness aspirations and cause doubts in even the most astute care routines.

With so many half-truths and rumors about them, it can be hard to know the true nature of an ACL tear. But beyond the injury’s reputation lies a treatable injury.

Dr. Peter Howard and his team know how frightening an ACL tear can be, but with injuries, as with all things, knowledge is power. Unwrapping the mystery around ACL tears is as easy as asking the right questions.


Your knees are made up of bones, ligaments, tendons, and cartilage. Ligaments connect bones to other bones. The anterior cruciate ligament (ACL), which is located in the front center of your knee, connects the thigh bone (femur) to the shin bone (tibia). It is one of four primary ligaments located in your knee:

  • Anterior cruciate ligament (ACL).
  • Medial collateral ligament (MCL).
  • Lateral collateral ligament (LCL).
  • Posterior cruciate ligament (PCL).

Critical for stabilization, the ACL can experience plenty of wear during any activity. A healthy ACL prevents the lower leg from sliding forward and helps us perform quick side-to-side motions, pivots, and other sudden changes in direction. While the ligament is most famous for ending professional athletic careers, its importance to any active individual can’t be overstated.

How Does an ACL tear?

In the heat of sporting or exercising, we can sometimes lose awareness of our posture, the angle of our foot, or how our leg is bent as we take a corner or turn to make a shot. Even professional athletes aren’t immune to a lapse of physical awareness.

Sudden and forceful changes in direction or momentum can impact the knee. Shifts in body weight rely on stability and our old friend: the ACL.

Direct blows to the knee can also cause tears in the ACL. Football or other physical activities can increase your risk of receiving a tearing injury.


ACL tears are usually recognizable by a “popping” sound or sensation from or in the injured knee. The injury is known to be painful and will usually prevent you from resuming the exercise or activity that caused it.

An injured knee struggles to bear weight and is accompanied by the expected symptoms: swelling and instability.

If you think you’ve experienced an ACL tear during any activity, it’s important to acknowledge the injury and seek medical help immediately. Attempting to “push through it” or “overcome the pain” can cause further damage.

Types of ACL Tears

When you hurt a ligament, it is graded on a one to three scale, with three being the most severe:

  • Grade One: Your ligament has been stretched, but it still does its job of stabilizing the knee joint.
  • Grade Two: Your ligament has been stretched and loosened. It’s partially torn. (This grade is rare.)
  • Grade Three: Your ligament is torn – divided into two pieces. This is a very severe injury.

ACL tears are often accompanied by injuries to the collateral ligaments, joint capsule, articular cartilage, or the menisci (cartilage pads).

Risk Factors

ACL tears are a very common knee injury. There are between 100,000 and 200,000 incidents every year in the United States. They’re common in athletes, especially those who do start & stop and sudden changes in direction sports like football, basketball, soccer, and volleyball. You’re also at a higher risk if you work a strenuous job that requires climbing, pivoting, or jumping.

An ACL tear can happen to anyone at any age, but females are four times more likely to have an ACL tear than males. Experts have yet to agree on why females are more prone. Some think this is because of different physical conditioning, neuromuscular control, or muscle strength. Others believe it’s because of a difference in the pelvis and lower leg alignment, looser ligaments, or how estrogen affects a woman’s ligaments. Differences in how women jump and land could also be a factor.

Diagnosis & Tests

A preliminary part of the diagnosis process is ruling out other possible reasons for your knee pain.

X-rays may be ordered to make sure no bones are broken. Your doctor will take a medical history and ask specific questions about the knee pain. They will examine the injured knee and compare it to your other knee. This examination is very accurate at detecting ACL tears.

An MRI will probably be ordered. MRIs show soft tissue damage, such as ligaments, and a torn ACL shows up clearly.

What questions might you be asked to help diagnose an ACL tear?

  • How did you injure your knee?
  • When did the injury happen?
  • When did the swelling start?
  • What part of your knee hurts?
  • Did you hear a sound when the injury happened?
  • Have you torn your ACL before?

Management & Treatment

What is the treatment for an ACL injury? It’s recommended to follow the RICE therapy method immediately after the injury:

  • R: Rest.
  • I: Ice.
  • C: Compression.
  • E: Elevation.

The type of treatment you receive is up to you. Many people with ACL tears decide to have surgery to return to the activities they did before the injury. If your activity level isn’t as high, you might choose not to have surgery.

But remember that your torn ACL won’t heal on its own.

Surgical Treatment

Surgery to reconstruct a torn ACL is done with a graft of a tendon (tendons connect muscles to bones) from your body, such as a hamstring (from the back of the thigh) or the kneecap/patellar tendon (from the front of the knee).

Occasionally, a cadaver tendon (a tendon from someone who died and donated their body to science) can be used in older individuals who are still very active. Because of the higher re-tear rates, cadaver tendons are typically not used in young athletes.

The surgery is minimally invasive, which means that instead of making a large incision with a scalpel, the surgeon uses an arthroscope, a thin wand-like instrument. The surgeon inserts the arthroscope and the working instruments through small incisions in your knee.

What Happens After ACL Surgery?

After surgery, you’ll need to keep your wound clean and dry. Use ice to reduce swelling and pain. You may use a brace and crutches. You’ll have physical therapy to strengthen your knee and its muscles. The first few days following surgery, you’ll perform gentle range of motion, simple strengthening, and some weight-bearing exercises. Physical therapy, including advanced strengthening and balance activities, usually starts within the first week.

After about 12 to 16 weeks, if you’re not an athlete, sport-specific activities are added to the rehabilitation program, such as hopping, jumping, and agility drills. An athlete should be able to return to normal activity about six to nine months after the ACL surgery.

Nonsurgical Treatment

Nonsurgical treatments include bracing and physical therapy:

  • Bracing: Putting a brace around your knee will keep it stable. You’ll have to use crutches, so you don’t put weight on that leg.
  • Physical therapy: Exercises will help your knee function and strengthen the leg muscles around it, supporting it.

Keep in mind that if you choose not to have surgery, you’re at a higher risk of re-injuring your knee.

Next Steps

As you can see, an ACL tear can be complicated. Choosing the right practice is important for your short and long-term performance. Fortunately, Dr. Peter Howard and his team have both the talent and experience to offer you the best ACL treatment available. So, if you’re having signs and symptoms of an ACL tear, don’t put yourself in a position of further risk. Contact us!