ACL Injuries

The ACL prevents the shinbone from sliding forwards beneath the thighbone. The ACL can be injured in several ways:

  • Changing direction rapidly
  • Slowing down when running
  • Landing from a jump
  • Direct contact, such as in a football tackle

ACL Injuries

How can one recognizing an ACL injury?
If you injure your ACL, you may not feel any pain immediately. However, you might hear a popping noise. Within 2 to 12 hours, the knee will swell, and you will feel pain when you try to stand. Apply ice to control swelling and elevate your knee until you can see an orthopedic surgeon.
If you walk or run on an injured ACL, you can damage the cushioning cartilage in the knee. For example, you may plant the foot and turn the body to pivot, only to have the shinbone stay in place as the thighbone above it moves with the body.

How does an ACL injury get diagnosed?
A diagnosis of ACL injury is based on a thorough physical examination of the knee. The exam may include several tests to see if the knee stays in the proper position when pressure is applied from different directions. Your orthopedist may order an X-ray and MRI (magnetic resonance imaging) or, in some cases, arthroscopic inspection.
A partial tear of the ACL may or may not require surgical treatment. A complete tear is more serious. Complete tears, especially in younger athletes, may require reconstruction.

How are ACL tears treated?
Both non-operative and operative treatment choices are available.

  1. Non-operative treatment:
    • May be used because of a patient’s age or overall low activity level.
    • May be recommended if the overall stability of the knee seems good.
    • Involves a treatment program of muscle strengthening, often with the use of a brace to provide stability.
  1. Operative treatment (either arthroscopic or open surgery)


Surgical treatment of the torn ACL usually involves an arthroscopic surgical reconstruction of the injured ligament. Although a number of different types of tissues has been utilized to reconstruct the ACL, the most commonly used tissues are the central third of the patellar tendon with a bone block at each end, or the semitendinosus tendon – a tendon in the medial to back of your knee. Though synthetic substitutes are available – they are used rarely owing to poor results in the initial stages and severe joint reaction, it incites.

Whichever tissue is chosen for the reconstruction of the ACL, it’s first taken from the respective part of the body- a procedure called “GRAFT HARVESTING”. This is resized – “GRAFT SIZING” and stretched out under tension to give it the strength and consistency of the original ACL – “GRAFT TENSIONING”. Once this procedure is completed, the new tissue is ready to be replace the torn ACL. Tunnels are prepared in the tibia and the femur at appropriate places to correspond to the position and attachment of the original ligament. The graft is then drawn into the joint and fixed at the sites of prepared tunnels with screws and miniature plates – which look more like the buttons of our shirt. Hence, these are called ENDOBUTTONS.