Anterior Cruciate Ligament (ACL) Tear

From Economou SG, Economou TS: Instructions for Surgery Patients. Philadelphia, WB Saunders, 1998, p. 377.

Description
An anterior cruciate ligament (ACL) tear is a 3rd degree sprain (tear) of one of the major ligaments of the knee. The ACL is a ropelike structure that helps maintain the normal position of the femur (thigh bone) and the tibia (lower leg bone). This ligament is important in sports that require pivoting, changing direction (cutting), or jumping and landing. This ligament does not heal when torn, although it may attach by scar tissue to other structures of the knee. About half the people who tear their ACL also have torn meniscus cartilage.

Common Signs and Symptoms – Notify a physician if these symptoms do not resolve within 72 hours:

Pop or tear heard or felt at the time of injury
An inability to continue playing after the injury
Large knee swelling noticed within 6 to 8 hours after the injury (often within 3 hours)
Inability to straighten knee
Knee giving way or buckling, particularly when trying to pivot, cut (rapidly change direction), or jump
Swelling with repeated giving way
Occasionally, locking when there is concurrent injury to the meniscus cartilage

Treatment
Initial treatment consists of ice and anti-inflammatory medication to relieve pain and reduce the swelling of the knee. Walking with crutches until you walk without a limp is often recommended (ability to put full weight on the injured leg). Range-of-motion, stretching, and strengthening exercises may be carried out at home, although usually referral to a physical therapist or athletic trainer is recommended. Occasionally your physician may recommend a knee brace, especially if other ligaments are injured along with the ACL. Rehabilitation of ACL tears usually concentrates on reducing knee swelling, regaining knee range of motion, regaining muscle control and strength, functional training, bracing (occasionally), and education, such as avoiding sports that require pivoting, cutting, changing direction, and jumping and landing. For those who perform sports that require pivoting, cutting, and jumping and landing frequently, surgery is usually recommended to allow return to these sports.

RICE Principle
With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

Rest- Walk with crutches if you cannot bear weight.
Ice- Use an ice pack for 20 minutes every two to three hours during the first 72 hours.
Compression- Use an ace wrap on the ankle. Start at the bottom of the toes and wrap up to mid-calf.
Elevation- Keep the injured ankle above the level of your heart when sitting or lying down