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ACL injury

An ACL injury is the tearing of the anterior cruciate (KROO-she-ate) ligament, or ACL, inside your knee joint. An ACL injury most commonly occurs during sports that involve sudden stops and changes in direction — such as basketball, soccer, tennis and volleyball.

Immediately after an ACL injury, your knee may swell, feel unstable and become too painful to bear weight. Many people hear or feel a "pop" in their knee when an ACL injury occurs.

Depending on the severity of your ACL injury, treatment may include surgery to replace the torn ligament followed by rehabilitation exercises to help you regain strength and stability. If your favorite sport involves pivoting or jumping, a proper training program may help reduce your chances of an ACL injury.

Symptoms Causes Risk factors Complications Prevention

At the time of an ACL injury, signs and symptoms may include:

  • A loud "pop" sound
  • Severe pain and inability to continue activity
  • Knee swelling that usually worsens for hours after the injury occurs
  • A feeling of instability or "giving way" with weight bearing

When to see a doctor

Most people seek immediate medical attention after an ACL injury.

Ligaments are strong bands of tissue that connect one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Most ACL injuries happen during sports and fitness activities. The ligament may tear when you slow down suddenly to change direction or pivot with your foot firmly planted, twisting or hyperextending your knee.

Landing awkwardly from a jump can also injure your ACL, as can falls during downhill skiing. A football tackle or motor vehicle accident also can cause an ACL injury. However, most ACL injuries occur without such contact.

Women are significantly more likely to have an ACL tear than are men participating in the same sports. Women tend to have a strength imbalance, with the muscles at the front of the thigh (quadriceps) being stronger than the muscles at the back of the thigh (hamstrings). The hamstrings help prevent the shinbone from moving too far forward during activities. When landing from a jump, some women may land in a position that increases stress on their ACL.

People who experience an ACL injury are at higher risk of developing knee osteoarthritis, in which joint cartilage deteriorates and its smooth surface roughens. Arthritis may occur even if you have surgery to reconstruct the ligament.

To reduce your chance of an ACL injury, follow these tips:

  • Improve your conditioning. Training programs that have been shown to be effective in helping to reduce the risk of ACL injuries typically include strengthening and stability exercises, aerobic conditioning, plyometric exercises, "jump training," and risk-awareness training. Exercises that improve balance also can help when done in conjunction with other training exercises.
  • Strengthen your hamstrings. Women athletes in particular should make sure to strengthen their hamstring muscles as well as their quadriceps.
  • Use proper techniques. If your sport involves jumping, learn how to land safely. Studies have shown that if your knee collapses inward when you land from a jump, you are more likely to sustain an ACL injury. Technique training along with strengthening of some of the hip muscles can help to reduce this risk.
  • Check your gear. In downhill skiing, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release appropriately when you fall.

Wearing a knee brace has not been found to be helpful in preventing ACL injuries.

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