ACL Tears
Background
The anterior cruciate ligament, or ACL, is one of the main ligaments that stabilizes the knee. It helps control forward movement and rotation of the shinbone, particularly when you cut, pivot, land, or change direction.
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An ACL tear can happen during a sudden change in direction or an awkward landing, even without contact with another athlete. It can also occur after a collision. Some people injure the meniscus, cartilage, or another knee ligament at the same time. Treatment depends on the knee’s stability, associated injuries, and the activities you want to return to.
Symptoms
An ACL injury may cause:
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A pop or shifting sensation at the time of injury
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Swelling that develops soon afterward
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Pain and difficulty putting weight on the leg
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Loss of knee motion
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A feeling that the knee may buckle or give way
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Difficulty returning to cutting, pivoting, or jumping sports
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Symptoms vary. Some patients can walk after an ACL tear but still experience instability when they try to return to sport.
Diagnosis
Dr. Fliegel will review how the injury happened, examine the knee for swelling and stability, and check for signs of meniscus or other ligament injuries. X-rays help evaluate for a fracture or associated bone injury. An MRI can confirm the ACL tear and show whether the meniscus, cartilage, or other ligaments were also injured.
Treament Options
There is no single treatment plan for every ACL tear. Dr. Fliegel will consider your age, activity demands, episodes of instability, other knee injuries, and personal goals when discussing the options.
Nonoperative Treatment
You can live and even stay active without an ACL. For some people, rehabilitation provides enough stability for daily life and straight-line activities. But if your knee repeatedly gives way or you want to return to sports that involve cutting, pivoting, and sudden changes of direction, operative intervention may offer a more reliable path back.
ACL Reconstruction
Reconstruction is commonly recommended for patients who want to return to sports that involve pivoting, experience repeated knee instability, or have other injuries that affect the treatment plan. During surgery, the torn ACL is replaced with a tendon graft. Dr. Fliegel will discuss graft options and whether any other injuries need treatment.
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Rehabilitation starts with restoring motion and strength, then progresses to running, jumping, cutting, and movements specific to your sport. Returning to sport depends on healing, strength, movement quality, and confidence, rather than time alone.
Return to Sport
Return to sport after ACL reconstruction depends on both graft healing and functional recovery. The graft continues to remodel for more than a year, so feeling strong alone does not mean the knee is ready for competition.
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Before clearance, patients complete return to sport testing that assesses strength, single leg hopping, landing and cutting mechanics, and confidence in the knee. Strength and hop performance are commonly expected to reach at least 90% of the uninjured leg. For pivoting sports, return is generally considered no earlier than nine months after surgery, and only when testing and sport specific progression support it.