Anterior Cruciate Ligament (ACL) Tear: Symptoms and Treatment
Rupture of the ligament that controls rotational stability of the knee, usually during sport.
The anterior cruciate ligament runs diagonally inside the knee and prevents the shin bone from sliding forward and the knee from rotating excessively. It may rupture during a sudden change of direction, an awkward landing or an abrupt stop — commonly in football, basketball, skiing and handball.
Symptoms
- A pop heard or felt at the moment of injury
- Marked swelling developing within the first few hours
- A sense that the knee cannot be trusted; giving way
- The knee buckling when changing direction
- Restricted range of motion
Swelling and pain may settle within a few weeks; this does not mean the ligament has healed. The persisting problem is rotational instability.
Diagnosis
Examination tests that measure forward translation and rotational stability establish the diagnosis in experienced hands. X-rays exclude accompanying fractures. MRI shows the ligament and the frequently associated meniscal and cartilage injuries.
Is Surgery Necessary?
The decision is based on age, activity level and whether the knee gives way — not on MRI alone.
Non-surgical management may be chosen for older patients whose lifestyle does not involve pivoting and whose knee remains stable, supported by a rehabilitation programme for strength and balance control.
Reconstruction is considered for younger and active patients, athletes, and anyone experiencing instability in daily life. The torn ligament is not sutured; it is rebuilt arthroscopically using a tendon graft.
Repeated episodes of giving way in an untreated, unstable knee may damage the meniscus and cartilage over time. The decision therefore considers the long term, not only current symptoms.
If you felt a pop during sport, if swelling developed rapidly, or if your knee gives way, seek assessment without delay.
Frequently Asked Questions
Does the ACL heal by itself?
A completely ruptured ACL is not expected to regain its original function. Reduced pain does not indicate healing; whether instability persists is determined by examination.
What happens if I do not have surgery?
If your lifestyle does not require pivoting and your knee does not give way, rehabilitation may be sufficient. However, repeated giving way increases the risk of meniscal and cartilage damage.
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