Sports Medicine
ACL and Knee Ligament Injuries
The anterior cruciate ligament (ACL) is one of the main stabilising ligaments in the knee. It prevents the shinbone from sliding forward and controls rotation. ACL injuries are common in sports with sudden stops, direction changes, and jumping.
What It Is
A Torn ACL Does Not Heal on Its Own
Treatment depends on your activity level, age, and goals. Some people function well without an ACL; others need surgical reconstruction to return to sport.
An accurate diagnosis — and an honest discussion of your goals — guides whether rehabilitation alone or reconstruction is the right path.
Symptoms
How an ACL Tear Feels
- At the time of injury — a popping sound or sensation, immediate swelling within hours, severe pain, and inability to continue activity.
- Afterwards — knee instability or giving way during activity.
- Difficulty walking or bearing weight
- Reduced range of motion and persistent swelling
Causes & Mechanism
Why the ACL Tears
Most ACL injuries occur without contact.
- Sudden deceleration while running; pivoting or cutting with the foot planted
- Landing awkwardly from a jump; a direct blow to the knee (less common)
- High-risk sports — football, basketball, skiing, tennis, and pivoting sports.
- Risk factors — female gender (2–8× higher risk), poor landing mechanics, muscle imbalance, and previous ACL injury.
Diagnosis
How an ACL Tear Is Diagnosed
01
Physical Examination
The Lachman and anterior drawer tests assess ACL integrity; the pivot-shift test assesses rotational stability.
02
MRI
Confirms the diagnosis and shows associated injuries — meniscus tears, other ligament damage, and bone bruising.
03
X-ray
Rules out fractures. The ACL itself is not visible on X-ray.
Treatment · Step One
Non-Surgical Treatment
Not everyone with an ACL tear needs surgery. Non-surgical treatment may suit older, less active people or those who do not play pivoting sports.
- RICE protocol — Rest, Ice, Compression, Elevation in the initial phase.
- Bracing — a hinged knee brace can provide stability during daily activities.
- Physiotherapy — restoring range of motion, strengthening muscles, and improving neuromuscular control.
- Activity modification — avoiding pivoting sports and high-risk activities.
Treatment · When Needed
ACL Reconstruction
Surgery is usually recommended for active individuals returning to pivoting sports, those with combined ligament injuries, or recurrent instability despite rehabilitation.
- The procedure — the torn ACL cannot be stitched back together; it is replaced with a graft from your own tissue (hamstring, patellar, or quadriceps tendon) or a donor.
- Timing — surgery is often delayed 2 to 4 weeks to let swelling settle and motion improve.
What to Expect
Recovery After Reconstruction
Early Recovery
Crutches, ice, and elevation, focusing on regaining extension. Gradual weight bearing and physiotherapy to restore motion and begin strengthening.
Building Strength
Progressive strengthening. Light jogging is typically allowed around month four.
Return to Sport
Sport-specific training, agility, and cutting drills. Return to sport when strength, stability, and functional tests are satisfactory.
Red Flags
Seek Emergency Care
See a doctor promptly if:
- The knee locks or catches and cannot be straightened
- Severe swelling develops within hours of injury
- You cannot bear any weight on the leg
- There is a visible deformity of the knee
- Numbness or tingling below the knee
Get Started
Suspect an ACL Injury?
Call +966 50 580 8852 for an evaluation with Professor Al-Othman.
Related
Related Sports Injuries
Tendon Injuries
Rotator cuff and Achilles tendon problems from overuse or sudden force.
Sports Medicine Hub
An overview of sports injury care — diagnosis, treatment, and recovery.