The anterior cruciate ligament is the primary restraint to forward translation and rotation of the tibia on the femur. Its rupture is one of the most common serious sports injuries, and how it is managed determines both the return to sport and the long-term health of the knee.
Most ACL ruptures are non-contact injuries: a sudden deceleration, a pivot on a planted foot, or landing from a jump with the knee close to extension and in valgus. Football, basketball, skiing, handball and volleyball account for the majority. Contact injuries from a direct blow to the outside of the knee are less common and more often associated with damage to other structures.
Patients typically describe a distinct pop at the moment of injury, immediate pain and an inability to continue playing. Swelling appears within a few hours — a rapid haemarthrosis is highly suggestive of an ACL rupture. Once the acute phase settles, the characteristic complaint is instability: the knee gives way on turning, on stairs or on uneven ground. Roughly half of ACL injuries occur with an associated meniscal tear, collateral ligament injury or bone bruising.
Diagnosis is clinical in most cases: the Lachman test is the most sensitive, supported by the anterior drawer and pivot shift. Radiographs exclude fracture and may show a Segond avulsion. MRI confirms the rupture, grades it as partial or complete, and — more importantly — identifies meniscal and chondral injury that changes the surgical plan.
No. Reconstruction is recommended for patients who wish to return to pivoting sports, for those with functional instability in daily life, for younger and more active patients, and when there is a repairable meniscal tear that needs the protection of a stable knee. Non-operative management with a structured rehabilitation programme is reasonable for lower-demand patients with no instability. The argument for surgery in the right patient is not only sport: repeated giving way damages the menisci and cartilage and leads to early arthritis.
The torn ligament cannot simply be sutured; it is reconstructed arthroscopically with a graft — hamstring tendons, bone–patellar tendon–bone or quadriceps tendon — passed through anatomically placed tibial and femoral tunnels and fixed under tension. Meniscal tears are repaired at the same operation whenever possible. The procedure is usually performed as a day case or with a single overnight stay.
Rehabilitation is the operation’s other half. Full extension and quadriceps control are regained in the first six weeks, jogging at three months, change of direction at four to six months, and return to competitive pivoting sport at nine months at the earliest, based on strength testing and hop symmetry rather than the calendar. Returning too early is the strongest predictor of re-rupture.
to guide you about your condition, to choose the best possible treatment.
