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Last Updated: Jan 10, 2023

All About Anterior Cruciate Ligament Injury

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Dr. P Sharat KumarOrthopedic Doctor • 36 Years Exp.FFSEM, MFSEM, DIP - SEM GB & I, MS - Orthopaedics, MBBS, MCh Orthopaedics
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Anterior Cruciate Ligament (ACL) injury is one of the most common knee injuries. Athletes who play high strain sports like football, rugby and basketball are more at risk in developing this kind of injury.
The ACL is one of the four primary ligaments in your knee. The injury occurs when the ligament is overstretched.

Signs and Symptoms:
ACL happens in steps:

  1. First, you might hear or feel in your knee a 'pop' sound
  2. Next, you might experience pain and an inability to move or continue with your activity
  3. Then your knee will swell up
  4. Lastly, hemarthrosis develops

The ACL injury can happen in various ways. Injury may occur if

  1. You change directions quickly
  2. You stop suddenly
  3. You slow down while running
  4. You jump and land incorrectly
  5. You are tackled, like in football, through direct collision or contact

The doctor will use the following tests to diagnose ACL injury:

  1. Pivot-shift test: This test is done to check for instability
  2. Anterior drawer test: This test is done to check for the suspected tear in the ACL
  3. Lachman test: This test more or less resembles the anterior drawer test. It is considered far more superior in diagnosing ACL injury than the anterior drawer test.


Treatment of ACL depends on the patient's age and lifestyle. A younger patient, who is involved in sports will need surgery to restore agility. An older patient can heal without surgery.

1. Conservative Management: This is recommended for people who are older and lead a quieter lifestyle. Also if the knee is overall stable, the doctor might opt for this treatment. Bracing and physical therapy is enough in this case. To protect the knee stability, braces are given. Crutches are also used to keep from exerting weight on the injured leg. When the swelling subsides, some exercises are performed. This is part of the rehabilitation program. Exercises will strengthen leg muscles that surround the knee.
2. Surgery: If the patient is young and has a very active lifestyle, surgery is very much needed. There are three surgical methods:

  • Primary repair- this method is not recommended barring bony avulsions, which are typically seen in adolescents
  • Extra-articular repair- generally includes a tenodesis of the iliotibial tract
  • Intra-articular reconstruction- this is the standard treatment for ACL injuries.

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