Diagnosis

During the physical exam, your doctor will check your knee for swelling and tenderness — comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint.

Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include:

  • X-rays. X-rays may be needed to rule out a bone fracture. However, X-rays don't show soft tissues, such as ligaments and tendons.
  • Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.
  • Ultrasound. Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.

Treatment

Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. Follow the R.I.C.E. model of self-care at home:

  • Rest. General rest is necessary for healing and limits weight bearing on your knee.
  • Ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
  • Compression. Wrap an elastic bandage or compression wrap around your knee.
  • Elevation. Lie down with your knee propped up on pillows.

Rehabilitation

Medical treatment for an ACL injury begins with several weeks of rehabilitative therapy. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee.

The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.

Surgery

Your doctor may recommend surgery if:

  • You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting
  • More than one ligament or the meniscus in your knee is also injured
  • The injury is causing your knee to buckle during everyday activities

During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon — tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft.

Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor.

After surgery you'll resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee.

There's no set time frame for athletes to return to play. Recent research indicates that up to one-third of athletes sustain another tear in the same or opposite knee within two years. A longer recovery period may reduce the risk of reinjury.

In general, it takes as long as a year or more before athletes can safely return to play. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk for ACL injury.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Preparing for your appointment

The pain and disability associated with an ACL injury prompt many people to seek immediate medical attention. Others may make an appointment with their family doctors. Depending upon the severity of your injury, you may be referred to a doctor specializing in sports medicine or a specialist in bone and joint surgery (orthopedic surgeon).

What you can do

Before the appointment, be prepared to answer the following questions:

  • When did the injury occur?
  • What were you doing at the time?
  • Did you hear a loud "pop" or feel a "popping" sensation?
  • Was there much swelling afterward?
  • Have you injured your knee before?
  • Have your symptoms been continuous or occasional?
  • Do any specific movements seem to improve or worsen your symptoms?
  • Does your knee ever "lock" or feel blocked when you're trying to move it?
  • Do you ever feel that your knee is unstable or unable to support your weight?
March 30, 2019
References
  1. AskMayoExpert. Anterior cruciate ligament (ACL) injury.Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
  2. Papadakis MA, et al., eds. Sports medicine & outpatient orthopedics. In: Current Medical Diagnosis & Treatment 2019. 58th ed. New York, N.Y.: McGraw-Hill Education; 2019. https://accessmedicine.mhmedical.com. Accessed Nov. 13, 2018.
  3. Friedberg RP. Anterior cruciate ligament injury. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2018.
  4. Anterior cruciate ligament (ACL) injuries. American Academy of Orthopaedic Surgeons. https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/. Accessed Nov. 13, 2018.
  5. Ellman MB, et al. Return to play following anterior cruciate ligament reconstruction. Journal of the American Academy of Orthopaedic Surgeons. 2015;23:283.
  6. DeLee JC, et al. Injury prevention. In: DeLee & Drez's Orthopaedic Sports Medicine: Principles and Practice. 4th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. https://www.clinicalkey.com. Accessed Nov. 21, 2018.
  7. Laskowski ER (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 24, 2018.
  8. Paterno MV, et al. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. American Journal of Sports Medicine. 2014;42:1567.