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ACL strain/tear

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ACL strain/tear



The most common cause of absence from sport or recreation, ACL injuries are typically seen in skiing, football and court based sports.  This injury usually occurs when landing from a jump, twisting, or slowing quickily.



The ACL is a ligament inside the knee that connects the femur to the tibia in such a way that it is a major contributor to both knee strength and control.  Because the ligament is intricately attached to structures with an excellent blood supply, this injury is often accompanied by large and rapid swelling (this is actually bleeding into the joint space of the knee and is known as a hemarthrosis).  Sometimes an audible ‘pop’ is heard with a feeling of something giving way.  The injury is associated with lots of pain and inability to carry on with the activity (although there are cases where people do carry on).


It is often surprising how easily this can happen, and most patients seek help about 24 hours after.  At this stage the swelling could be very significant and so examination can be difficult.  It is best to seek help earlier but this is seldom ever the case.



  • Pain and rapid swelling (this can be delayed though)
  • Inability to move the knee or bear weight
  • Pain can be widespread throughout the knee because injuring this ligament will happen alongside other injuries too.



  • Clinical testing to assess any laxity of the ligament – this is not the most sensitive way of assessing as there may be a degree of laxity prior to the injury.  It should always be done in comparison to the other leg.
  • X-Ray can be useful in highlighting if the ligament has been pulled away from the bone.
  • MRI will highlight any bone bruising also.



  • Remember that not all ACL injuries involve a tear or rupture.  At this, rehabilitation exercises are often opted for as opposed to surgery.
  • Surgical decisions are made around several criteria (age, disability, associated injuries, occupation, activity levels etc), and not every case is the same.
  • There are numerous surgical approaches to reconstructing the ACL.  Some use tendons from other areas like your hamstrings and a new ligament is constructed from that and implanted.
  • Depending on the surgical methods used, the rehabilitation will be different.
  • Rehabilitation will be extensive and long (up to a year) involving exercises graduating from non weight bearing to weight bearing to balance training to explosive speed work.
  • Manual therapy to aid full joint movement.


Exercise Videos: i.e.

  • Rotator cuff strengthening
  • Pec stretch
  • etc






Put an ‘X’ next to each health professional that most commonly deals with this injury.

i.e. tennis elbow would be Physio and Medic as injections are common, whereas for muscular LBP it would be Physio and not Medic as they would just refer them to a Physio.

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