when to be concerned about an ACL injury

in this article:

• What is the ACL?
• What are the signs of an ACL injury?
• How do you treat an ACL injury?

About 250,000 ACL injuries occur every year in the United States. Adolescents, females and athletes in pivoting/cutting sports, like soccer or basketball, tend to have more ACL injuries than their peers. It’s likely you know someone that has torn their ACL. In fact, it’s one of the most common injuries for athletes ages 15-45.

We asked Melissa Martinek, DO, PhD, pediatric orthopedic surgeon at Dayton Children’s, to share why ACL injuries occur, symptoms of an ACL injury and how ACL injuries are treated.

what is the ACL?

The anterior cruciate ligament (ACL) is a thick band of tissue that is made up of lots of fibers, like a rope. It is one of the main connector/stabilizers of the upper leg bone (femur) to the lower leg  (tibia/fibula).

how does an ACL injury occur?

The ACL can be stretched or torn by forcing the knee beyond it’s normal motion. This often happens when changing direction rapidly or pivoting, slowing down from running or landing a jump. Injuries can can result from a non-contact knee injury or direct blow to the knee.

As mentioned, athletes in pivoting or cutting sports, tend to have more ACL injuries due to the quick changes in direction their sport requires which can stress the ligament.

what are the signs of an ACL injury?

If your child has injured their ACL, they may have felt a sudden “pop” with pain deep in their knee. There is usually significant swelling in the knee that develops within a few hours of injury. Your child may have limited knee motion due to pain and swelling. The knee may feel unstable, buckle or “give out.” It is common for pain to resolve within a week or two. This does not mean the ACL is healed.

how is an ACL injury diagnosed?

An orthopedic or sports medicine provider will check the knee for stability, movement and tenderness. They will compare the injured knee to the uninjured knee. X-rays will be done to look for damage to the knee bones and may show swelling in the joint. More testing may be done if your child’s provider thinks they have an ACL tear or other damage to cartilage, the meniscus or ligaments. An example of further imaging is an MRI. An MRI shows damage to ligaments, tendons, muscles and cartilage.

how do you treat an ACL injury?

When the ACL is torn it does not heal on its own, and the knee becomes unstable. Without the ACL controlling knee movement, the knee bones are more likely to rub against each other with activity. This leads to further injuries of the tissue that covers the ends of the bones (cartilage) and can trap and tear the pads that cushion the knee joint (meniscus).

The orthopedic/sports medicine provider may want to do some imaging tests to further define the injury.  These tests can include X-rays and/or a CT scan or MRI. The radiologist and orthopedic surgeon will carefully review the images from the tests to determine the extent of the injury. Then, the surgeon will discuss with you and your child the best treatment option based on age, lifestyle and future goals. This could include surgery. If the ACL is sprained, sometimes it can be rehabilitated without the need for surgery. However, ACL tears usually go on to need reconstruction to give the patient a stable knee, followed by physical therapy and bracing.

If you suspect your child has an ACL injury, you can schedule an appointment online with one of Dayton Children’s U.S. News & World Report-ranked orthopedic surgeons/ sports medicine physicians.