How to tell if you tore your ACL (Anterior Cruciate Ligament):
- Audible 'Pop' or 'Crack' at the instance of injury
- The feeling of the knee giving out
- Difficulty or inability to bear weight with the injured leg
- Intense sensation around the knee joint (e.g., pain, tingling, numbness)
- Loss of range of motion
- Rapid swelling
- Knee joint stiffness
- Loss of stability
- 'Wobbly' leg when attempting to walk
If you think you may have torn your ACL based on these symptoms, it is imperative to see an orthopedic surgeon or go to the ER as soon as possible.
ACL Functions
The primary function of the ACL is to stabilize the knee joint by preventing the tibia (shin bone) from sliding in front of the femur (thigh bone).
About the knee joint, there are four ligaments, two collateral (MCL, LCL) and two cruciate ligaments (ACL, PCL).
Cruciate ligaments work together to allow the knee to move back and forth.
The ACL is essential for stability, especially during particular athletic movements.
What Causes ACL Tear?
ACL tears typically occur during athletic movements that stress the knee joint.
Contact and non-contact injuries are possible mechanisms of injury, although non-contact ACL tears are more common.
What Causes ACL Tear?
- Pivoting with firmly planted foot
- Quickly changing direction (cutting)
- Awkwardly landing
- Rapidly coming to a stop
- Receiving a direct hit to the knee joint
ACL Tear Risk Factors
ACL tears are erratic injuries. Although, there are factors that increase your chances of suffering a torn ACL.
- Females are more prone to ACL tears
- Football, basketball, soccer, and tennis athletes
- Developing improper movement patterns (e.g., jumping, landing, squatting)
- Rapidly coming to a stop
- Receiving a direct hit to the knee joint
- Playing on turf as opposed to grass
How To Tell If You Tore Your ACL?
- Audible 'Pop' or 'Crack' at the instance of injury
- The feeling of the knee giving out
- Difficulty or inability to bear weight with the injured leg
- Intense sensation around the knee joint (e.g., pain, tingling, numbness)
- Loss of range of motion
- Rapid swelling
- Knee joint stiffness
- Loss of stability
- 'Wobbly' leg when attempting to walk
In the instance of injury, a loud pop or crack followed by the knee giving out may occur. It will likely be painful and put you into a state of shock.
You might be able to get back on your feet and start walking within seconds, although you should avoid doing this if at all possible.
If you walk soon after an ACL tear, you may realize that your knee has lost stability. It might feel as if your knee is hyperextending with each step.
Rapid swelling occurs, followed by severe knee stiffness, with the range of motion decreasing.
What Should I Do?
Experts recommend getting off your feet as soon as possible. Have someone help transport you to somewhere you can lie down. Rest, ice, compression, and elevation (RICE) is the best way to combat the rapid swelling and lingering pain.
As soon as possible, have someone help get you to the ER.
At the ER, an examination which may include an x-ray will occur. If appropriate, an orthopedic referral for further inspection will follow.
Do I Need Surgery For Torn ACL?
The severity of the tear influences the need for ACL reconstruction surgery.
In some partial-tear cases, orthopedists recommend holding off on surgery and giving time to see if the ACL heals itself.
If the ACL has been ruptured (completely torn), surgery is the viable option for anyone looking to return to athletic activity.
Once the ACL tear occurs, the meniscus cartilage of the knee bears much of the stabilization responsibilities. Knee stability and mobility suffer without the ACL.
Over time, the meniscus is worn down and inevitably causes osteoarthritis. Kids, younger adults, or anyone wishing to participate in athletic activities should strongly consider ACL reconstruction.
Physical therapy may be a more sensible alternative to surgery. Whether this option makes sense depends on your lifestyle, age, and aspirations.
How Does ACL Reconstruction Work
1.) Patient is put under anesthesia.
2.) 2-3 small, non-invasive incisions are made at specific points on the knee. These incisions are for the surgical utensils to enter (e.g., cameras).
3.) One slightly larger incision is typically made.
4.) Remanence of old ACL is removed.
5.) Autograft is taken from the hamstring, patella, or another tendon (discussed pre-surgery with your surgeon). If allograft is being used, no autograft is taken.
6.) Graft is put in place of old ACL and secured to the femur and tibia with 2 small screws respectively.
7.) Tools are removed and the patient is sewn up.
8.) Patient wakes up (usually out for 2.5-3 hours). After being kept in post-op for an hour or two, the patient is sent home the same day.
9.) ACL Regeneration Stage 1: Cell Death (Necrosis); the body tears down all living cells of the graft, leaving a blueprint for the new ACL to grow. This process takes approximately four weeks.
10.) ACL Regeneration Stage 2: Proliferation; an influx of patient’s cells to graft. During proliferation, the ACL graft is at its weakest, and most susceptible to graft failure (especially in weeks 6-8). This process takes about eight weeks.
11.) ACL Regeneration Stage 3: Ligamentation; Beginning about 3 months after surgery, ligamentation is when the ACL begins to gradually become stronger and more like the original ligament. The graft will continue to grow stronger for at least a year.
What Is ACL Surgery Like?
A sample trip to the hospital for ACL surgery may look like…
1.) Check in at the hospital.
2.) Meet the nurse and change into a hospital gown.
3.) Hooked up to IV fluids.
4.) Meet an anesthesiologist (often puts mild anesthetics into IV fluids).
5.) Wheeled into operation room (OR).
6.) Greeted by surgeon and assistants.
7.) Anesthesiologist places a mask over your mouth and instructs your breathing.
8.) Take 5 deep breaths. 1, 2, 3… and you are awake in the recovery room.
9.) You will most likely be a little confused and disoriented. You may be nauseous and dizzy, especially when you eventually stand.
10.) Your leg will probably be in some amount of pain. Painkillers are prescribed accordingly to help with the pain. RICE and Advil are other pain treatments. The first few days are when the worst pain occurs.
11.) Physical therapist greets you in the recovery room to help you figure out walking with crutches.
12.) 1-2 hours after surgery, you will be wheeled out of the recovery room and sent home.
Message For ACL Recovery
ACL tears are one of the worst sports-related injuries.
As someone currently recovering from an ACL rupture, I have learned much about the injury and how ACL reconstruction works. I have also experienced firsthand the ACL rehabilitation process.
Surgery is no fun, but for anyone looking to regain sufficient knee stability and mobility, surgery is definitely worth the negatives.
Beginning the day after surgery, every day gets better and brings you closer to returning to sports.
If you are curious about what ACL-tear recovery looks like, I hope my insight and personal experience can be helpful and potentially answer questions such as “how to tell you I tore your ACL?”
ACL Tear Recovery Timeline
The truth about ACL recovery is that it takes time. There is no way to speed up the biological processes that heal the ligament.
Although, staying diligent with physical therapy and rehab exercises will give you the best chance of making a successful and speedy recovery.
The more effort you put into rehabilitation, the better the chance of successful recovery.
Consider that tearing the ACL graft is a real possibility. Individuals who tore their ACL are at heightened risk of re-tear and tearing their other ACL.
Disclaimer
The following timeline is an example of how an ACL recovery could look.
It is imperative to listen to your healthcare professionals, for it could differ from the information below. Not all ACL recovery protocols are the same.
ACL Recovery Weeks 1-2 (Post-OP)
The most challenging part of the ACL rehabilitation journey. The first few days after surgery are the most painful and testing.
Having some movies, games, or books lined up is a good idea because there is a lot of lying around not doing much.
During this time, everything is going to be a challenge.
Pedestrian activities like showering become arduous. Although, each day while you heal, these tasks shrink in difficulty.
Something that worried me following surgery was the bandages and wondering how gruesome the wounds were underneath them. To my surprise, when I eventually was permitted to remove them (48 hours post-operation), it was not that bad.
I found three small hole-like incisions around my knee and one slightly larger incision inferior to my knee cap. It was not nearly as bad as I thought it would be.
CPM Machine Instructions
For the 5-10 days following surgery, your surgeon may recommend the use of a CPM machine.
This machine automatically bends your knee for you and helps achieve knee flexion goals.
If recommended by your orthopedist, I strongly recommend buying or renting a CPM machine.
The first few days after surgery are incredibly painful and the knee gets very stiff.
Taking my knee out of my brace and putting it into the CPM machine was the remedy for pain reduction that worked the best for me.
Goals
- Restore knee extension (passive)
- Reduce the swelling about the knee
- Work up to 120 degrees of knee flexion
- Full weight bearing (with brace locked)
New Activity
- May unlock brace while sitting
- Standing (with brace locked)
- Walking with crutches for balance
- Sleeping/lying down with brace locked in extension
- Rest, ice, compression, and elevation (RICE) to combat pain and swelling
Potential Exercises
- Ankle pumps (prevents clotting)
- Knee flexion (CPM machine)
- Patellar massage, patella movement
- Straight leg raises (brace locked)
- Heel slides
ACL Recovery Week 3 (Early Rehab)
Week 3 typically marks the start of rehab.
Initial physical therapy appointments usually get scheduled around the third week after surgery.
For me, ACL recovery week 3 was when the road to recovery became much more apparent.
If you wish to fully recover, you cannot overlook physical therapy and the rehab exercises they prescribe. They are vital to a successful rehab.
Goals
- Relearn normal walking pattern
- Maintain passive knee extension
- Continue to increase knee flexion
- Further reduce swelling
- Re-establish muscular control (injured leg)
- Improve proprioception and neuromuscular connection
New Activity
- Unlock brace while walking (given adequate quad control)
Potential Exercises
- Active straight leg raises (without brace)
- Hamstring curls against gravity (active)
- Weight shifting
ACL Recovery Weeks 4-6 (Early Rehab)
Weeks 4-6 of rehab continue to build on what started in week 3.
It is exciting to start using your leg again in ways you once did and feel the progress with each rehab session.
Walking without a brace is a great feeling and a true marker of progress.
Goals
- Continue to increase knee flexion
- Further reduce swelling
- Re-establish muscular control (injured leg)
- Improve proprioception and neuromuscular connection
- Wean out of brace week 5
New Activity
- Walking without brace
Potential Exercises
- Isometric quad sets
- Hamstring curls against gravity
- Stationary bicycle on low resistance
- Single-leg balance
- Initial core exercises reintroduced
ACL Recovery Weeks 7-12 (Continued Strengthening)
The 7-12 week period can feel redundant.
Although, each week, your knee will feel better and better. Less swelling, more strength, increased muscle mass, better movement, etc.
Even though your knee will start feeling good during this time, the ACL graft is actually at its weakest point (proliferation). It is vital to follow your doctor’s and physical therapist’s recommendations.
The last thing you want to do is re-tear your new ACL graft.
Goals
- Normalized walking
- Range of motion back to normal (within 1° of the other leg)
- Improve lower body strength
New Activity
- Walking up and down the stairs normally
Potential Exercises
- Bodyweight leg press machine (0-30°)
- Hamstring curls
- Core strengthening exercises
- Lateral step-overs
- Balance training
- Lateral step-ups
ACL Recovery Weeks 13-16 (Advanced Strengthening)
After the somewhat boring six-week period of Continued Strengthening, the following weeks become much more exciting.
During this phase, you will start jogging again, progress to standard double-legged squats, and eventually to single-leg squats.
Depending on your progress, you may begin jump training by the end of this phase.
Typically, jump training may not begin until a sports brace is acquired. Finally, you will see your hard work paying dividends in this phase.
Goals
- Re-establish normal lower body strength
- Improve muscular strength and endurance
- Continue to improve neuromuscular control
New Activity
- Jogging
- Plyometrics
Potential Exercises
- Progress with all strengthening exercises
- Side lunges
ACL Recovery Weeks 20+ (Sport-Specific Rehab)
Weeks 20 is the ‘final’ stage of your rehab.
At this point, it has been nearly five months since your surgery.
Finally, you will begin a gradual return to sports after being cleared by an orthopedist.
Goals
- Gradual return to sport
- Progress with skill training
- Work towards max strength
- Achieve max muscular endurance
New Activity
- Running
- Cutting
- Progress with plyometrics
- Return to sports (gradual)
Potential Exercises
- Progress with all strengthening exercises
- Agility training
- Advance plyometric training
- Running exercises
ACL Recovery 6 Months
ACL recovery 6 months out is usually when a clinical examination (with a surgeon or an orthopedist) will take place.
This visit is necessary to evaluate rehabilitation progress and determine whether or not you are well-suited to return to sports.
Ask any further questions you may have at this appointment.
Sport-specific rehab will continue for as long as needed/recommended.
When you return to sports, a sports brace is needed for several months.
The biological processes within the knee take over a year to fully reconstruct the new ligament.
How Long Until I'm Fully Recovered?
Sport-specific rehab will continue for as long as needed/recommended.
The biological processes within the knee take over a year to fully reconstruct the new ligament.
When you become ‘fully’ recovered is hard to say. It truly depends on case to case.
Medical science continuously improves, allowing athletes to return to sports more quickly.
Athletes have been able to make a full recovery in as little as six months.
Although, that is the very best case scenario.
A more realistic aspiration to have is nine months. Many recoveries take even longer; upwards of a year-long recovery is not uncommon.
Regaining total confidence in your knee without the sports brace takes over two years.
All that said, the most critical piece of ACL recovery is to stay optimistic and to be persistent with rehab.
Give yourself the best chance for a full ACL recovery by concentrating on physical therapy and rehab exercises. They make a significant difference.
ACL Tear Prevention Exercises
- Squats
- Lunges
- Hip adduction
- Hip abduction
- Core strengthening exercises
- Jumping technique training
- Landing technique training
- Dynamic stretching
- Static stretching
Re Rupture ACL Graft Symptoms
Re rupturing an ACL graft can be a scary possibility post-surgery. Symptoms of a re-ruptured ACL graft are very similar to the original tear.
How to tear tell if you tore your ACL (graft) will follow the same protocol.
How To Tell If You Tore Your ACL (Re Rupture)
- The feeling of the knee giving out
- Difficulty or inability to bear weight with the injured leg
- Loss of range of motion
- Rapid swelling
- Knee joint stiffness
- Loss of stability
Contact your physical therapist or orthopedist as soon as possible if you think you re-tore your ACL graft.
Listen to your healthcare professionals to best avoid a re-tear.
Can You Run With A Torn ACL?
Yes.
Technically you can run with a torn ACL.
When the ACL gets torn, the meniscus takes over stabilization responsibilities.
Running does not require much stabilization, so the meniscus is sufficient.
Although, avoid running if possible. Running with a torn ACL can be painful and lead to meniscus damage.
During ACL reconstruction surgery, your surgery can repair any meniscus damage. So, if you do damage your meniscus, it is not the end of the world.
How Long After ACL Reconstruction Can I Swim?
In most cases, it will take roughly 5 months until you can swim again.
Some rehab programs include exercises such as pool walking and pool running earlier than 5 months post-surgery. If you cannot wait to get back in the pool, this might be something to get excited about.
ACL vs Meniscus Tear
The meniscus is rubbery cartilage that acts as a cushion for the femur as it rests on the tibia.
The ACL is a durable, elastic ligament located behind the kneecap. It stabilizes the knee and prevents the femur from sliding behind the tibia.
An injury to either the ACL or meniscus will cause issues with mobility.
If you think you injured your knee, see an orthopedist as soon as possible.
Initially, symptoms of the two injuries may appear similar. Pain, swelling, and worsened mobility are symptoms common with both.
Although, an ACL tear will likely produce an audible ‘pop’ or crack at the time of the injury. The knee giving out and being unable to bear weight are signs that there may be ACL damage.
Regarding treatment, minor meniscus tears will heal with rest.
More severe meniscus damage may require surgery or physical therapy.
ACL tears are much more severe. In most cases, ACL tears warrant surgery for a full recovery.
ACL vs Meniscus Tear Which Is Worse?
ACL tears are significantly more severe knee injuries than meniscal tears.
Notable ACL Recoveries
The torn ACL is an injury that affects athletes far and wide. From youth to adults playing recreationally, all the way to the professional level.
Players from the NBA, NFL and many other sports leagues suffer from this injury.
Tom Brady Torn ACL
Tom Brady, one of the greatest athletes in the history of sports, suffered a torn ACL in 2008.
Brady received a direct blow to his knee from Bernard Pollard, resulting in a torn ACL.
He would miss the entire 2008 season.
Subsequently, Tom Brady would win four more championships, three more super bowl MVPs, and two more regular season MVPs. Additionally, Brady has broken nearly every passing record and is still playing at an MVP-caliber level today, at age 45.
For individuals looking for inspiration for their ACL recovery, look no further than TB12.
Kyle Lowry Torn ACL
The all-star NBA point guard Kyle Lowry suffered a torn ACL before his professional career began.
In 2004 while playing college hoops at Villanova, Kyle Lowry tore his ACL.
Following a remarkably speedy recovery, he returned to play. Lowry was so successful that his #1 jersey was retired at Villanova and subsequently was selected number 24 in the 2006 NBA draft.
Kyle Lowry has since been a six-time NBA all-star and is an NBA champion.
Dalvin Cook Torn ACL
Pro-bowl Minnesota Vikings running back Dalvin Cook tore his ACL in his rookie season.
Post-injury Dalvin Cook has developed into one of the league’s most explosive offensive weapons.
Year after year, Cook puts up big numbers for Minnesota.
If you are an athlete worrying if you will ever return to being the player you once were, use these comeback stories as proof that it is possible to make a full recovery to your sport.
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References
Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738
Jeremy Wood MD – https://www.jeremywoodsonmd.com/blog/what-does-your-acl-do
Mount Sinai – https://www.mountsinai.org/health-library/injury/anterior-cruciate-ligament-acl-injury
Kids Health – https://kidshealth.org/en/parents/acl-injuries.html
Hospital for Special Surgery – https://www.hss.edu/condition-list_acl-surgery.asp
UCSF Health – https://www.ucsfhealth.org/education/after-acl-surgery
Texas Heath Center for Diagnostics and Surgery – https://thcds.com/blog/difference-between-meniscus-tear-and-acl-tear/
Bleacher Report – https://bleacherreport.com/articles/55016-tom-brady-possibly-out-for-season-with-acl-tear
Sportskeeda – https://www.sportskeeda.com/basketball/top-5-active-nba-players-bounced-back-following-acl-tear/2
Cooley Dickinson Medical Group – https://www.cooleydickinson.org/wp-content/uploads/2016/11/Rehabilitation-following-ACL-Reconstruction.pdf