ACL Injuries: Getting You Back To the Playing Field

“An ACL injury is one of the most common knee injuries,” said John Kahl, PT, DPT, SCS, CSCS, Catholic Health Physical Therapist. “Although it typically happens to athletes while playing sports, it can also happen after a fall or from sudden movements like quickly stopping while in motion.”

Mr. Kahl explained that an ACL injury requires immediate assessment from an orthopedist. Whether surgery is needed or not, physical therapy is a critical step to full recovery. Working with a physical therapist pre-surgery and after surgery will ensure the injury fully heals so you can resume normal activities, especially if you are an athlete returning to sports.

What is the ACL?

“It is important to know the anatomy of the knee and the role the anterior cruciate ligament (ACL) plays to understand injuries to the ACL,” said Mr. Kahl.

Many ligaments support the knee. The following are four of the main ones that help to provide joint stability.

Cruciate Ligaments

Anterior cruciate ligament (ACL). Located in the middle of the knee and prevents excessive forward sliding of the shin bone on the thigh bone, inward (valgus) stress, and rotation.
Posterior cruciate ligament (PCL). Works with the ACL to prevent excessive backward sliding of the shin bone on the thigh bone, as well as rotation.

Collateral Ligaments

Medial collateral ligament (MCL). Runs along the inside of the knee and primarily prevents the knee from bending inward.
Lateral collateral ligament (LCL). Runs along the outside of the knee and primarily prevents the knee from bending outward.

The ACL plays an essential role in stabilizing the knee joint, so if it is injured, your knee may feel unstable or shift when you put weight on it.

What are the types of ACL injuries?

Tears of the anterior cruciate ligament are either complete or partial. A scale of one (least severe) to three (most severe) grades the extent of the injury.

Grade one injury. An injury to the ACL, but the ligament fibers remain intact.
Grade two injury. A partially torn ACL that may result in knee instability. The injury may heal without surgery.
Grade three ACL injury. A completely torn ACL. It is the most common grade of ACL injury and will likely require surgery, depending on your goals.

When the ACL tears, other injuries can occur to surrounding tissues in the knee, including the other knee ligaments, meniscus and articular cartilage.

What causes an ACL injury?

“ACL injuries may happen when an athlete makes contact with another athlete, such as when someone falls on the knee, causing it to move in an unnatural direction,” said Mr. Kahl. “They can also be caused by non-contact injuries that occur during pivoting, cutting, or jumping movements.”

He explained that participation in sports such as basketball, football, lacrosse, soccer and skiing, which involve sprinting, deceleration, cutting and jumping, puts significant force on the knee and may increase the risk of an ACL injury.

Although most common in sports, ACL injuries can also happen to non-athletes as well because of specific movements, including:

Cutting: suddenly slowing down and changing direction
Jumping and landing awkwardly
Suddenly stopping
Pivoting while the foot is firmly planted
A trip and fall

What are the risk factors for ACL injuries?

Potential risk factors for ACL injuries include:

Gender: Females are more likely to experience an ACL injury
Anatomy of the knee
Participating in sports with pivoting, cutting, and jumping
Sports equipment and uneven playing surfaces
Activity demands (Especially those that far exceed an individual’s current physical preparation and conditioning.)
Neuromuscular control deficiencies

Mr. Kalh noted that these risk factors do not guarantee an injury.

What are the symptoms of an ACL injury?

“You’ll often hear a popping sound in your knee,” said Mr. Kahl. “The knee may also ‘give way,’ making the joint feel unstable.”

Other common symptoms include:

Pain
Swelling
Loss of range of motion
Tenderness to touch
Discomfort when walking or inability to walk normally
Difficulty to bear weight on the affected leg when standing

When should I seek treatment for an ACL injury?

“Seek treatment quickly!” said Mr. Kahl. “The sooner you have your knee evaluated, the sooner you can start down the path to recovery.”

ACL injuries are often diagnosed through physical examination and imaging tests, such as an MRI. An orthopedist or physical therapist may also perform a Lachman test or anterior draw test to assess the integrity of the ACL ligament.

How are ACL injuries treated?

Treatment options vary according to the extent of the injury.

Surgery

Complete tears and partial tears with instability typically require surgery. An ACL reconstruction involves replacing the torn ACL with a graft taken from the individual’s body, such as the patellar tendon. The surgery aims to restore the knee's stability, allowing a return to high-impact or regular activities with a reduced risk of re-injury. Post-surgery rehabilitation is crucial for successful recovery.

Physical therapy

Whether an individual requires surgery or not, a physical therapy program is vital—especially for athletes who want to get back on the playing field. Athletes who have surgical reconstruction will typically have nine to 12 months of physical therapy.

Working with a sports physical therapist soon after an ACL injury will help you regain function and heal appropriately. A comprehensive exercise program will be the cornerstone of a successful recovery.

Exercises may include:

Squats, lunges and knee extensions to strengthen the quadriceps and other thigh muscles.
Running, jumping, and cutting exercises to prepare athletes for the demands of sport.
Mobility exercises to restore joint range of motion.
Strengthening the ankle, hip, and core muscles to support the knee joint.

Your physician and physical therapist will perform tests throughout your recovery to evaluate your progress while in rehabilitation. Formal functional testing typically occurs around five to six months after surgery, including range of motion, swelling, balance, strength, agility, jumping ability, and psychometric readiness. Repeat testing evaluates whether the athlete is safe and prepared to return to sporting activities.

“Even if someone is progressing exceptionally well, patients are encouraged not to rush their recovery,” said Mr. Kahl. “Rushing your recovery can significantly increase your risk for a second ACL injury.”

He explained that a care team will also focus on psychological health.

“Experiencing an ACL injury that takes you off the playing field can be difficult and frustrating,” he said. “It is important that athletes are one hundred percent confident and mentally prepared to return to the activities that they love.”

For patients who have ACL injuries that do not require surgery, physical therapy is still strongly recommended. It helps the ligament heal and teaches important exercises that can help reduce the risk of it happening again.

Find Care at Catholic Health Physical Therapy & Rehabilitation

Catholic Health Physical Therapy & Rehabilitation is Long Island’s leader in physical therapy. Our dedicated physicians and physical and occupational therapists offer tailored treatments and programs at locations across Nassau and Suffolk County.

Our experts in ACL injuries conduct ACL screenings for student athletes who participate in community and school sports teams. Our therapists assess athletes’ balance, range of motion, jumping ability and agility to identify risk factors and suggest ways to avoid ACL tears.

Appointments are available throughout the week at: