Anterior Cruciate Ligament (ACL)

An ACL tear is one of the most common and serious ligament injuries of the knee. It typically occurs during sudden changes in direction, stopping, jumping, or twisting movements of the knee. A tear refers to a complete rupture of the ligament and often requires surgical treatment, especially in active individuals.

What is an Anterior Cruciate Ligament (ACL) Tear?

The ACL is an important ligament located in the center of the knee that connects the thigh bone (femur) to the shin bone (tibia). It controls forward movement and rotational motion of the knee. When this ligament is torn, the knee loses stability.

How Does an ACL Tear Occur?

ACL tears most commonly occur in the following situations:

Sudden changes in direction (e.g., during soccer, basketball, or skiing)
Excessive load on the knee when landing from a jump
Direct impact to the knee (e.g., in a car accident)
Hyperextension of the knee (overstretching)

What Are the Symptoms?

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Symptom Explanation

“Pop” Sound At the moment of injury, a popping or snapping sound may be heard in the knee.

Sudden Severe Pain Immediate and intense pain occurs in the knee.

Knee Instability A feeling of the knee “giving way” occurs, causing a sense of insecurity and imbalance.

Swelling Usually develops within the first few hours after the injury.

Limited Range of Motion Bending or straightening the knee becomes difficult.

How is the Diagnosis Made?

Physical Examination: The knee is evaluated using special tests such as the Lachman test and pivot shift test.
Magnetic Resonance Imaging (MRI): Provides a clear view of the ACL tear, as well as any meniscus or cartilage damage.
X-Ray: Used to check for bone fractures (ligament tears are not visible on X-rays).

Conservative Treatment (Non-Surgical)

Conservative treatment is generally preferred for older, less active individuals. Physical therapy and the use of a knee brace are employed to help maintain quality of life.
Goal: To reduce pain and improve knee function.
However, in cases of complete tears, knee instability may make sports and an active lifestyle difficult.

Surgical Treatment (Reconstruction)

Surgical reconstruction is generally the best option for active individuals and athletes.

Surgical Procedure:

The torn ligament is removed.
A graft is typically used to replace it:
Autograft: Tissue taken from the patient’s own tendons (hamstring or patellar tendon).
Allograft: Donor tissue is used (less commonly preferred).
The procedure is performed arthroscopically (minimally invasive).
Recovery Process:
First 2–3 weeks: Crutches and ice therapy.
4–6 weeks: Gradual weight-bearing begins.
3–6 months: Physical therapy continues to restore strength and mobility.
6–12 months: Return to sports.
Return to sports is usually recommended after the 9th month. Returning before the knee has fully regained strength increases the risk of re-injury.