Your ACL provides important stability in the knee. If left untreated, ACL tears can alter joint mechanics and lead to arthritis later in life. You may also be more likely to injure yourself in other ways since, without a functioning ACL, the knee is more likely to buckle during activity.
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How is an ACL injury diagnosed?
If you've injured your knee, a sports medicine specialist will perform a physical exam. They may touch the knee, look at the swelling, and talk to you about your injury, including what you were doing before, during, and after the injury occurred. They may also perform ACL tear tests by moving your leg into different positions to see what causes pain and assess your mobility.
Your doctor may perform an MRI scan of your knee if they suspect an ACL tear. The MRI uses magnetic fields to produce high-resolution pictures of the inside of your body. It can show your knee in great detail, allowing the doctor to evaluate the extent of your ACL injury.
It's hard to tell on your own whether you have a sprained or torn ACL. The symptoms are similar in both cases, but more severe in a complete tear or rupture. A doctor will conduct a physical examination and perform ACL tear tests to investigate, but the best way to tell if an ACL is torn or sprained and the extent of injury is with an MRI scan that can show the damage clearly.
Depending on the extent of the injury, you may be unable to stand, or even straighten your leg, due to pain and reduced ability to activate the quadriceps (thigh muscles). This ability usually returns gradually as the swelling decreases and your range of motion increases.
ACL injury treatments
After examining your knee and reviewing the MRI, your doctor will help determine the degree of ACL injury: low-grade sprain, partial tear, or complete rupture of the ACL.
ACL sprains are the least severe ACL injury, and will most often be treated with nonsurgical approaches, such as anti-inflammatories, ice, rest, and physical therapy. More severe ACL injuries, including severe ACL tears, might require surgery after your range of motion and strength improve. Your doctor will assess your knee stability and discuss your options with you.
The good news is that many patients who have ACL surgery recover well and return to their sport after adequate recovery and rehabilitation.
Learn more about ACL injuries and how Mass General Brigham Sports Medicine department can help you.
ACL surgery
Your doctor is more likely to recommend surgery to reconstruct or repair the damaged ligament if you’re an athlete who relies on your strength and agility to perform. They are also likely to recommend surgery if you struggle to return to regular physical activity or have damaged more structures in your knee than just the ACL.
The ACL has limited blood supply and can't usually heal by itself. Because of that, complete tears might require surgery if you continue to feel instability in the knee with physical activity. There are two main types of surgery, called ACL reconstruction and ACL repair.
- ACL reconstruction surgery: During this procedure, the surgeon replaces the damaged ligament entirely with a tissue graft. The type of graft varies based on your sport, activity level, age, and other factors that the surgeon will discuss with you.
- ACL repair surgery: For ACL repair surgery. the surgeon sews the ACL back together, instead of replacing it. This ACL surgery is less common than ACL reconstruction. In most circumstances, it has a lower success rate than reconstruction, but doctors are testing new techniques that may make ACL repair a better option in the future.
Mass General Brigham Sports Medicine physicians utilize cutting-edge sports medicine research, technology, and treatment. We specialize in various nonsurgical and surgical treatment options for the full spectrum of knee conditions.
Nonsurgical ACL injury treatment
Mild ACL injuries may heal without surgery, following an ACL injury self-care plan similar to your recovery plan after surgery. Whether you require surgery to fix your ACL or not, you will need to follow a rehabilitation program to heal from your injury:
- Resting gives the structures in your knee time to heal and regain weight-bearing strength.
- Icing and elevating your knee multiple times a day reduces inflammation and swelling.
- Pain and anti-inflammatory medications can help to reduce swelling and pain.
- Regular physical therapy can strengthen the muscles in your knee and recover a full range of motion.
- You may use a sports brace, which can provide compression and extra stability during physical activity.
How long does a torn ACL take to heal?
Connective tissue injuries like ACL tears heal slowly because there is limited blood supply to the damaged tissue. The worse your injury, the longer your ACL recovery time might be, and the higher your risk of developing other issues over time, such as knee arthritis.
ACL injury recovery times vary. Everyone is different, but complete recovery often takes a year or more. Physical therapy is crucial to recovering from an ACL tear. A good rehabilitation program will focus on regaining motion and strengthening the muscles around your knee.
Your doctor will have you wear a brace with controls to adjust the range of motion allowed. You'll start with your leg locked straight. As you progress with exercises and physical therapy, you'll gradually unlock the brace to increase range of motion.
A comprehensive rehabilitation protocol like Mass General Brigham’s will establish clear criteria for progression based on strength and mobility, so you’ll understand when it's safe to move on to more challenging exercises.
Your doctor and physical therapist will be able to answer any questions you have about the details of your program and guide you through new or unfamiliar exercises.
Minor ACL injuries may heal with rest, ice, and other conservative therapies. However, the ACL is more resistant to healing than other ligaments in the knee, because it is surrounded by a joint fluid that inhibits the healing process. As a result, many ACL tears cannot heal on their own.
Yes, it's possible to re-tear your ACL after it's been repaired or reconstructed. Some studies show that ACL tears are more likely among those who have already had a prior ACL injury than among uninjured individuals. Athletes should be cautious after their surgery to avoid re-tearing their ACL.
A torn ACL can feel like devastating news, especially for a competitive athlete. Fortunately, an ACL tear isn't the career-ending injury it once was. Many athletes can return to high-level play after their recovery. However, they need to be patient, careful, and especially attentive to their form and technique once they return to play. Secondary tears are more common in those who have had prior ACL injury. Take your time to ensure a full recovery before you start training again.
Also, ACL reconstruction, which takes tissues from elsewhere in the body (such as the hamstring, quadriceps, or patellar tendon), may change your biomechanics, knee strength, or other aspects of your body and movement. Even if you return to competition after ACL surgery, you may need to make adjustments.
Our dedicated sports medicine team can help you recover from ACL injuries and reduce your risk of reinjury. We have a multidisciplinary team of doctors who work in concert to develop a customized treatment plan tailored to your unique needs and goals. Request an appointment or call us at 617-726-0500 to learn more. You can also schedule a virtual visit with a Mass General Brigham sports medicine specialist to begin your recovery journey today.
