The anterior cruciate ligament (ACL) is one of the main stabilising ligaments in the centre of the knee. It stops the shin bone sliding forward and controls twisting movements.
ACL tears usually happen without contact: changing direction suddenly, stopping sharply or landing awkwardly, in sports such as soccer, rugby, netball, basketball and skiing. Many people feel or hear a pop, followed by swelling within a few hours. Afterwards, the knee may give way, especially when turning.
A clinical examination can usually detect an ACL tear. An MRI scan confirms it and shows any damage to the meniscus, cartilage or other ligaments, which is common.
No. A torn ACL doesn’t heal back together on its own, but some people, particularly those who don’t play pivoting sports, manage well with a structured rehabilitation programme. Reconstruction is generally recommended for people who want to return to sports involving twisting and turning, those whose knee keeps giving way, and when there is other damage in the knee that needs repair.
ACL reconstruction is done arthroscopically. The torn ligament is replaced with a graft, usually taken from your own hamstring, patellar or quadriceps tendon, which is passed through tunnels in the bone and fixed in place. In selected patients, a lateral extra-articular tenodesis may be added to improve rotational control. Any meniscus tear is treated at the same time.
Risks include infection, stiffness, graft failure or re-injury, pain at the graft site, blood clots, and numbness around the incisions. Re-injury is more likely after an early return to sport, which is why rehabilitation milestones matter.
Dr S. Khan, Dr S. Baba