Signs and Symptoms
Typical signs of an ACL tear include:
- A pop felt or heard at the moment of injury
- Swelling that develops within a few hours
- Pain and difficulty continuing to play or walk normally
- Loss of full motion, especially straightening the knee
- A feeling that the knee shifts or gives way, particularly when turning or changing direction
Once the early pain and swelling settle, some people feel fairly normal walking in a straight line but notice the knee buckles with cutting, pivoting or stepping off at an angle.
What Causes It?
Most ACL tears are non-contact injuries. They happen when you plant your foot and change direction quickly, stop suddenly, or land from a jump with the knee turned inward. Sports such as soccer, basketball, football, tennis, pickleball, skiing and dance carry a higher risk. A direct blow to the side of the knee can also tear the ACL.
An ACL tear often comes with other injuries, such as a meniscus tear, a sprain of the MCL (the ligament on the inner side of the knee) or a bone bruise. Identifying these matters because it changes the treatment plan.
How We Diagnose It at POPB
Your physician will examine the knee with specific stability tests that check how far the shin bone moves forward. X-rays are taken on site to rule out a fracture, and an MRI can be done in our office to confirm the ACL tear and look for meniscus, cartilage or other ligament injuries.
ACL tears are treated by Dr. Wolfson and Dr. Chalal, both fellowship-trained in sports medicine. They will talk with you about your sport, job and goals before recommending a plan.
Non-Surgical Treatment Options
A torn ACL does not heal back together on its own in most cases, but not everyone needs surgery. Non-surgical care may be reasonable if you are less active, do not do pivoting sports and do not have repeated giving way. It includes:
- Early care with ice, elevation, compression and crutches as needed
- Physical therapy in our office to restore motion, then build strength and balance, with your therapist working from the same chart as your physician
- Activity changes that avoid cutting and pivoting
- A brace for certain activities, when helpful
If the knee keeps giving way despite therapy, reconstruction is usually recommended, because repeated instability can damage the meniscus and cartilage.
Surgical Options
ACL reconstruction replaces the torn ligament with a graft, a piece of tendon taken from your own knee or from a donor. It is done arthroscopically, through small incisions with a camera, at one of the surgery centers where our surgeons operate, and most patients go home the same day.
Dr. Wolfson and Dr. Chalal perform ACL reconstruction. Dr. Wolfson uses an all-inside quadriceps tendon technique, and a meniscus tear found at the same time is often repaired during the same operation. Many surgeons recommend physical therapy before surgery to reduce swelling and regain motion, which can make recovery smoother.
Recovery
Recovery from ACL reconstruction is gradual. Most people walk with crutches and a brace for the first weeks, work on straightening and bending the knee early, and progress to strengthening, balance and then running over the following months.
A return to cutting and pivoting sports usually takes about 9 to 12 months and depends on strength and movement testing, not just time. Physical therapy is done in our office, so your therapist and surgeon can review your progress together. Timelines vary from person to person.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, MRI, physical therapy and medically necessary ACL reconstruction, subject to your co-pay, co-insurance and deductible. Some plans require prior authorization for MRI or surgery, so ask our team.
HMO and managed-care plans require a referral from your primary care physician before your visit. If you were hurt on the job, we coordinate care and documentation through workers' compensation.
When to Be Seen
Call our office soon after a knee injury with a pop, fast swelling or a feeling of instability, or if the knee keeps giving way. If the leg looks deformed, you cannot bear any weight, or your foot becomes cold, numb or pale, go to the emergency room or call 911.
