Clinically reviewed by What is acl injury
The ACL, or anterior cruciate ligament, is one of two ligaments that cross over inside the knee. It stops the shin bone sliding forward on the thigh bone and controls the knee when you turn. Without it the knee is stable for walking but unreliable when you pivot.
An ACL tear happens in a moment: the foot planted, the body turning, often with no contact at all. Many people feel a pop, the knee swells within a couple of hours, and it feels as though it gave way.
A completely torn ACL does not normally join back together. That does not mean an operation is automatic. ACL surgery recovery has its own page.
Symptoms you might have
- A pop or snap felt inside the knee at the moment of injury
- Swelling within one to two hours, which is blood in the joint and the most telling sign
- A feeling that the knee shifted or came apart for an instant
- Being unable to carry on playing, even though walking may be possible
- The knee giving way later when turning, stepping sideways or on uneven ground
- Difficulty fully straightening the knee because of the swelling
- A knee that feels fine in a straight line and unsafe the moment you change direction
Why it happens
- Twisting with the foot planted, which is how most ACL tears happen
- Landing awkwardly from a jump, with the knee rolling inwards
- Sudden braking or a sharp change of direction in football, cricket or badminton
- A blow to the outside of the knee, which can injure the ACL and the inner ligament together
- Playing on hard, uneven ground in ordinary shoes rather than studs
- Motorbike and road accidents, which can injure several structures at once
- Weak thigh and hip muscles and poor landing control
- A previous ACL injury on either knee
When you should see a physiotherapist
Come in early even if surgery is being discussed. A knee that goes into theatre straight, with a working thigh muscle and no swelling, recovers much better. If surgery is not planned, rehabilitation is the treatment, and it works for a lot of people.
Go to a hospital the same day if the knee swelled up a lot within a few hours of the injury. That needs an orthopaedic assessment, and the meniscus may be involved too.
Go the same day if the knee locked and will not straighten, or if it is hot, red and swollen with a fever. Go immediately if the leg or foot is pale, cold, numb or tingling, which can mean the blood supply or nerves were injured.
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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How it is treated
Everyone with an ACL injury starts the same way, whether or not they end up having surgery: settle the swelling, get the knee fully straight, and get the thigh muscle working.
- Swelling control with compression, elevation and cryotherapy in the first weeks
- Range of movement work, with full straightening as the priority
- Exercise therapy, progressive strengthening of the quadriceps, hamstrings, glutes and calf. This is the treatment, not an add on
- Neuromuscular and balance training, teaching the knee to control rotation, which is what the ligament used to do
- Manual therapy for a stiff knee or kneecap once the swelling settles
- Bracing for a limited period where the knee is unstable or the surgeon has prescribed it
- TENS and electrotherapy for pain relief early on
- Graded return to activity, straight line first, then change of direction, then sport
Not everyone needs an operation. Surgery is usually advised for people returning to pivoting sport, for a knee that keeps giving way after three months of rehabilitation, and when a repairable meniscus tear is present. That judgement is the surgeon's.
Exercises, and what to avoid
What helps
- Static quadriceps and heel props to get the knee completely straight in the first two weeks
- Sit to stand, then step ups, then single leg work as strength allows
- Hamstring and glute strengthening, which control the forward slide the ACL used to stop
- Single leg balance work, from the floor to a cushion, eyes open then closed
What to avoid
- Twisting, pivoting and side stepping until strength and control have been rebuilt
- Returning to football or cricket because the knee feels fine. Feeling fine comes long before being ready
- Deep squats and lunges while the knee is swollen
- Repeated episodes of giving way. Each one risks damaging the meniscus and the joint surface
What you can do at home
Get the knee straight. Lie on your back with the heel on a cushion and nothing under the knee, ten minutes several times a day, and let gravity do it.
Ice and compression while the knee is swollen, ten to fifteen minutes with a cloth against the skin. Elevate above hip level.
Use crutches while you limp. Walking with a limp for weeks teaches the leg habits that take longer to undo than the limp itself.
Work the thigh muscle every day from the start. It is the muscle that keeps the knee safe.
Avoid uneven ground and wet floors while the knee is unreliable. Most giving way episodes happen in ordinary places, not on the field.
How long it takes
The swelling and the worst of the pain settle over three to six weeks. Walking normally usually returns in two to six weeks.
If you are treating it without surgery, three months of serious rehabilitation is the fair trial. By then it is clear whether the knee is stable for the life you want. Many people do well in daily life and in straight line activity such as gym work, running and cycling.
Returning to pivoting sport after a reconstruction is usually nine to twelve months, and depends on passing strength and hop testing rather than on the date.
Recovery is slower when the meniscus is also torn, when the knee stays swollen, and when the thigh muscle is slow to come back.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
اے سی ایل گھٹنے کے اندر کی لیگامنٹ ہے جو گھومنے کے وقت گھٹنے کو سنبھلتی ہے۔ یہ پیر زمین پر رکھ کر جسم گھومنے سے ٹوٹتی ہے، اور گھٹنا جلدی پھول جاتا ہے۔
چوٹ کے بعد گھٹنا جلدی پھول جائے تو اسی دن ڈاکٹر کو دکھائیں۔ اگر گھٹنا سیدھا نہ ہو، یا پیر ٹھنڈا، سفید یا سن ہو جائے، تو فوراً ہسپتال جائیں۔
پوری طرح ٹوٹی ہوئی اے سی ایل خود جڑتی نہیں، لیکن ہر مرض میں آپریشن ضروری نہیں۔ گھومنے والے کھیل کھیلنے والوں کو اکثر آپریشن چاہیے ہوتا ہے، باقی بہت سے لوگ صرف ورزش سے ٹھیک چلتے ہیں۔
شروع میں سب کا علاج ایک ہے: سوجن کم کرنا، گھٹنا سیدھا کرنا، اور ران کی طاقت واپس لانا۔
Roman Urdu
ACL ghutne ke andar ki ligament hai jo ghoomne ke waqt ghutne ko sambhalti hai. Ye pair zameen par rakh kar jism ghoomne se tootti hai, aur ghutna jaldi phool jata hai.
Chot ke baad ghutna jaldi phool jaye to usi din doctor ko dikhayen. Agar ghutna seedha na ho, ya pair thanda, safed ya sun ho jaye, to foran hospital jayen.
Poori tarah tooti hui ACL khud jurti nahi, lekin har marz mein operation zaroori nahi. Ghoomne wale khel khelne walon ko aksar operation chahiye hota hai, baqi bohat se log sirf warzish se theek chalte hain.
Shuru mein sab ka ilaj aik hai: sujan kam karna, ghutna seedha karna, aur raan ki taqat wapis lana.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Do I definitely need surgery for an ACL tear?
Can a torn ACL heal on its own?
How do I know I tore my ACL and not something else?
How long before I can play cricket again?
Will an ACL tear give me arthritis later?
Related conditions
- Plantar fasciitis and heel pain treatment
- Knee osteoarthritis and knee joint pain
- Ankle sprain treatment
- Ankle pain treatment
- Arthritis treatment