Most ACL injuries occur after a non-contact twisting injury. ACL tears can also occur after being struck on the side of your leg. Most athletes will pivot or twist, run and feel a pop in their knee. Then they are left wondering “Did I Tear My ACL”?
I’ve heard the story far too many times… A high school or college athlete was running, they went to change direction on the field and felt a pop or snap within their knee. Most athletes do not continue playing after the injury occurred . Many athletes will tell me that they tried to get up and walk but their knee felt unstable so they sat back down. Within a few hours the knee will start to swell and walking on that leg will become difficult. An examination by an Athletic Trainer on the field, or the team physician immediately after the injury can usually determine if the ACL is torn. After the knee swells and the pain worsens it is more difficult to examine these knees to see if there is an ACL tear.
Did I Tear My ACL?
In athletes under 25 years of age, a swollen knee following a turning, twisting or pivoting injury means that you have a 75% chance that your just tore your ACL. At this point you should be assisted off the field. Many, but not all athletes will require crutches to help them walk. If your knee feel loose or unstable if might be because of an ACL tear. Do not attempt a return to activities until you have been examined by a Sports Doctor.
Your first visit to a Sports Medicine doc will include X-rays to be sure that there are no fractures, a less common cause of swelling and pain. A good examination will be able to determine if the ACL is torn. Perhaps even more important, the examination should determine if the ACL was the only ligament torn. Multi-ligament injuries do exist and in those circumstances we might need to consider repairing all the injured ligaments. ACL tears can occur with MCL injuries. ACL injuries can also occur with injuries to the outer or lateral side ligaments too. Sometimes you will only suffer a partial ACL tear … the MRI and exam both need to support that diagnosis.
An MRI will be used to confirm the injury, but more important, to rule out any injury to the cartilage or meniscus.
An interesting and worthy note. We know that patients who tear their ACL are at risk for developing osteoarthritis. Early studies show that an anti-inflammatory injection soon after the injury might diminish that risk.
ACL Injury/Surgery Related Questions:
- What are the best first steps after an ACL tear?
- Xray, examination and MRI: An xray is important to make sure you did not fracture anything at the time of the injury. On occasion the bone where the ACL attaches will actually pull off or break. An MRI is useful to confirm that the ACL is injured, however, it is more important to look for any associated injuries such as a meniscus tear.
- Possible steroid injection- early research is showing it might decrease the risk of future arthritis.
- Should I start physical therapy?
- Physical therapy prior after injuring your ACL and prior to ACL surgery is very important. Recent research shows that the results of surgery might be better if PT if performed before ACL surgery. Physical therapy after ACL surgery is extremely important to minimize the risk of reinjury to the ACL.
- Do I need surgery for my ACL tear?
- Many people who tear their ACL will need surgery to stabilize the knee.
- There are some people who may not need surgery on their ACL. Many older folks who are weekend warriors may do very well without surgery. In this post we asked 5 expert ACL surgeons who they consider is a good candidate for ACL surgery.
- How do you choose a surgeon for your ACL?
- Volume and experience matter… we discuss this here.
- Which graft should I use for my ACL surgery?
- Graft choices for ACL surgery is a complex topic. In this post we have 5 ACL experts discuss their graft choice for ACL surgery. In this video we discuss the options available for those considering ACL surgery here.
If you have a swollen and painful knee after a twisting injury you should strongly consider an examination by a Sports Medicine physician to evaluate your knee for an ACL tear.