Everyone’s heard of someone tearing their ACL or sustaining ACL Injuries – think of Lindsey Vonn this past Winter Olympics. She tore her ACL when coming out of retirement and returning to downhill ski competition and felt ready to go. She worked with her team of highly trained professionals in rehabilitation to be able to compete. Unfortunately, though, because the ACL wasn’t there to do it’s job, she suffered a much worse injury when she fell during the Olympics.
What is the ACL?
The ACL’s full name is the Anterior Cruciate Ligament. It’s a ligament located within the knee joint connecting the femur (the bone in the upper half of the leg) to the tibia (a bone in the lower half of the leg). The ACL’s job is to provide stability in the knee by ensuring that the tibia doesn’t move forward and it doesn’t rotate too far from the femur. There are other ligaments and muscles that also help the ACL out in stabilizing the knee.
How do you tear the ACL?
The ACL tears when the stress on the ligament is too high to allow for it to do its job which results in a failure or rupture of the ligament. There are many factors at play with this including general strength of the leg muscles, training capacity and load, and overall tolerance/adjustment to activity. Two ways that you can tear your ACL tear are through (1) non-contact and (2) contact:
- A non-contact injury would be when no one is around you. The ACL will tear from this when the foot is planted firmly on the ground with the tibia being still while the body is going in a different direction.
- A contact injury occurs when something or someone runs into your leg while it’s planted and forces an involuntary change in direction of the body.
When an ACL tears, there is a possibility that it didn’t tear all the way and hasn’t fully failed.
- Grade III – A full tear of the ligament. Meaning it has fully failed and is not offering any support to the knee joint.
- Grade II – A partial tear of the ligament. These are diagnosed when 20-80% of the ligament’s fibers are torn.
- Grade I – The least of severity, meaning there is only a tear in some of the muscle fibers (less than 20%).
Who is at risk for an ACL tear?
If you’re ever in a situation where your foot is planted and your body changes direction involuntarily, you can be at risk for an ACL tear. Although, these injuries more often happen in an active population who is participating in sport activity that has frequent changes in direction and you’re not at high risk in your day-to-day life.
How do I know if I’ve torn my ACL?
When the ligament fails and a full tear is present, there’s usually a very intense pain in the knee and a popping sound associated with it. When the ligament partially tears, some of the following symptoms may not be present right away.
Other symptoms may include:
- Increased swelling the day of a few hours later
- Feeling like the knee is going to give out
- Difficulty with moving the knee into a full bend
- Difficulty with going up or down stairs
- Trouble with walking normally, feeling like your walking pattern has changed.
- Pain and difficulty with running or doing fast paced activities.
When is it time to see a Doctor?
If you have concerns about an ACL injury, you should seek help immediately. Your trusted care team can consist of a lot of people and it’s hard to figure out who the best person to see. The most effective personnel in diagnosis of this injury is going to be someone who specializes in the musculoskeletal system. This would include either a Physical Therapist or Orthopedist.
How long does recovery take?
Recovery times range heavily based on the grade of the tear, your current strength and overall activity level, and your body’s healing timelines with both surgical and conservative (non-surgical) approaches.
Surgical Treatment
With surgery, recovery times also vary. This is most dependent on the type of graft (what tendon the new ACL is made up of) the surgeon uses and your rehabilitative care team’s practice and approaches. Research continues to show a longer delay of return to sport (9-12 months) provides the best chances of a stable ACL and reduction in re-tear rates.
Conservative (Non-surgical) Treatment
Without surgery, you can still live a full and active life. My grandfather had neither ACL repaired from ages 35–85. He still was still able to continue his career as a collegiate and professional football and basketball referee until he retired. At retirement, he was still able to play with his kids and grandkids.
When choosing to go the route of a conservative approach to treatment, strength and stability of the knee is of the highest importance with this approach. Getting back to your activities relies heavily on ensuring all of the supporting muscles are able to do their job AND the job of the ACL to keep the knee stable and reduce chances of additional injury. This can take anywhere from 12 weeks to a year.
Get started with physical therapy by giving us a call at 703-450-4300!
