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anatomical model of a knee joint
anatomical model of a knee joint
anatomical model of a knee joint

by Adam Brown    MClScPT    FCAMPT
Registered Physiotherapist
updated July 18, 2020


An ACL rupture is a significant injury and patients always have a lot of questions. At Cornerstone Physiotherapy in Toronto we have helped countless patients recover from ACL tears. Many of whom have had ACL reconstruction surgery and many who have successfully rehabilitated their injury without surgery.  These are the most frequently asked questions that we hear from patients about ACL tears.


What is the ACL?

ACL is an acronym for Anterior Cruciate Ligament. It is an important ligament in your knee that provides stability to your knee joint.


Where is my Anterior Cruciate Ligament?

It is in the centre of your knee joint between your tibia, or shin bone and your femur or thigh bone. You can not touch your ACL from the outside of your knee.


Anatomical model of a knee joint highlighting the ACL or anterior cruciate ligament


What Does The ACL Do?

Your ACL helps to keep your knee joint aligned by preventing your tibia or shin bone from sliding forward and out of alignment with your femur. It also helps to prevent excessive twisting or rotation between these bones.


How Do I Know if I Have Torn My ACL?

The most certain method for evaluating if an ACL is torn is with an MRI image of the knee. [insert MRI images]  Of course it is not always possible to get an MRI quickly, so clinicians rely on a few other factors. The following are common features of a torn ACL.

MRI of a knee joint highlighting a torn ACL or anterior cruciate ligament
MRI showing a torn ACL in the knee
  • If the injury occurred from a twisting motion on your leg with your foot fixed in place on the ground. This will commonly occur with a rapid change in direction.
  • Rapid swelling within two hours after the original injury.knee with the lateral joint line highlighted
  • You may have heard or felt a ‘pop’ at the time of injury.
  • You may have tenderness along the lateral joint line. {image}
  • Your knee may feel ‘loose’ or as though it ‘gives out’.


Physiotherapists and physicians commonly use two evaluation techniques to assess if an ACL is torn.

The Lachman Test:

In this test the clinician is determining if the ACL is still stopping forward translation of the tibia on the femur.



The Pivot Shift Test:

In this test the clinician is evaluating if the ACL is restraining rotational movement of the tibia on the femur.



Using these tests and the information from a detailed history of the injury an experienced clinician can accurately diagnose an ACL tear.


Can You Walk With a Torn ACL?

Most people who tear their ACL will find it difficult to walk initially due to the swelling and trauma. Once swelling has subsided most patients are able to regain a normal walking pattern even though their ACL is still torn.

ACL’s are not always the only thing injured. Some people will injure other parts of their knee like their MCL (Medial Collateral Ligament) or the menisci. If these structures are injured it can make it difficult to walk.


How Do You Tear Your ACL?

The ACL is most commonly torn from a pivoting movement when the foot is fixed on the ground and the body rotates over the foot such as when performing a ‘cutting’ movement in sport. However, any trauma or movement that causes the lower leg to rotate or slide forward relative to the femur is capable of tearing an ACL.


How Long Does an ACL Tear Take To Recover?

First, the ACL does not heal on its own after it is torn. Many people can recover from an ACL rupture and have a stable knee after participating in a rehabilitation program. Others will require surgical reconstruction in order to restore adequate stability to the knee. If a patient is able to recover without surgery it usually takes 4-6 months. If surgery is required the recovery will typically take 9 months to a year.


How Do I Know If ACL Surgery Necessary?

Surgery is necessary if after completing a physiotherapy program the knee is not stable enough to do all of your usual activities without ‘giving way’ or subluxating. Everyone’s knee is different and must be evaluated to see if surgery is necessary. Many people’s knees are stable enough after rehab to participate in their usual activities, especially if they partake in activities that do not involve rapid changes in direction or pivoting movements. While some people will continue to experience ‘giving way’ of their knee even after rehabilitation. These people require an ACL reconstruction in order to prevent further injuries. If you participate in pivoting sports you are more likely to require surgery to safely return to full participation.


When Can I Run After ACL Surgery?

Most patients can begin to run three months after having their ACL reconstructed. It is important to note that this pertains to ‘straight line’ running, not pivoting or cutting drills. It is also important to start with a very short distance and slowly increase your mileage. The knee should not swell after running. If it does swell, it is an indication that you either did too much, or the knee is not yet ready.


When Can I Return To Sport After ACL Surgery?

This will be up to your surgeon. Most surgeons now require that their ACL patients refrain from returning to sport participation for 9 months following surgery. Some surgeons will allow a return to sport at 6 months. This decision will be based on the stability of your knee, how well rehabilitation has gone, what type of ACL graft was used and what activity you are returning to.

It has been shown that patients who wait for 9 months to return to sport are less likely to rupture their ACL graft than those who return at 6 months.


Will My Torn ACL Cause Arthritis?

A ruptured ACL is a major trauma to the knee joint. As a result people tend to develop more arthritis in the knee that suffered an ACL rupture than their opposite knee. This is the case whether you undergo a surgical reconstruction or not.

For more information on ACL ruptures, check out this article from our physiotherapy friends in Ottawa.

ACL tears are common, but that does not mean they are not serious. It is a major knee injury that requires the right treatment. Not only have our physiotherapists helped hundreds of patients in Toronto recover from ACL injuries, many of us have torn our own ACLs. We know exactly what you are feeling. Give us a call (below), we would be happy to answer your questions and help you to find out the best way to handle your ACL tear.

About the author

Adam Brown

Co-founder, Physiotherapist Learn More about Adam Brown

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