An anterior cruciate ligament is the knee’s primary stabilizer and is vital for knee function in jumping, cutting, and aggressive running. It keeps your tibia from moving forward over the femur and prevents rotation between these two bones. ACL injuries are common among athletes when the ligament partially or fully tears. A sudden change in direction or speed can tear your ACL. The injury can lead to severe pain, swelling, an inability to add weight to your injured leg, and lost range of motion (ROM).

At Suarez Physical Therapy, we recognize that the healing journey after your ACL injury can be challenging. It requires expert care and an individualized and holistic approach to ensure the best results. When you work with our skilled physical therapists in Las Vegas, we can help you build the functionality and strength needed to return to your daily activities. Our commitment goes beyond helping you return to your pre-injury degree of wellness. We can help you enhance your resilience, strength, and functionality to avoid downtime.

Defining Anterior Cruciate Ligament Tear

Anterior cruciate ligament tears are injuries to your ACL in the knee.

An anterior cruciate ligament is a knee ligament that connects your femur (thigh bone) to your tibia (shin bone). It forms an “X” shape in the knee with the posterior cruciate ligament.

It is like a strap connecting bones and stops the knee from rotating or bending a lot. Things that apply force on the knee to twist or bend more than the standard limit can tear or injure your ACL.

An injured ligament is a sprain and is categorized on a seriousness scale. The scale includes the following:

  • Grade 1 — Your ligaments are mildly damaged. While the ligaments are stretched, they can keep your knee steady.

  • Grade 2 — The sprain stretches your ligament until it is loose. It is also called a partial ligament tear.

  • Grade 3 — Also called the ligament’s complete tear. The ligament is pulled off your bone or torn in two, making your knee joint unstable.

Anything that exerts much force on the knee could tear the ACL. Typical causes of ACL include falls, car accidents, and sports injuries. There are different ways ACL tears occur, including the following:

  • Changing direction suddenly

  • Slowing down while running

  • Direct collision or contact like a football tackle

  • Landing from a jump wrongly

Female athletes are more likely to suffer from ACL injuries than their male counterparts in specific sports. It could be due to variations in muscular strength, neuromuscular control, the impact of estrogen on ligament characteristics, loose ligaments, lower extremity and pelvis alignment, and physical conditioning.

While anyone can sustain an ACL, sporting activities like football, soccer, lacrosse, gymnastics, and basketball cause more injuries.

Signs and Symptoms

Once you hurt your ACL, you could experience any of the following signs and symptoms:

  • Hearing a popping sound or feeling the knee giving out from under you

  • Pain mainly when you add weight on the knee

  • Losing the ROM

Complications to Expect

ACL tear-causing injuries can also injure other components of the knee.

Patients with ACL injuries are more likely to develop knee osteoarthritis. Arthritis can happen even when you undergo a surgical procedure to reconstruct your ligament.

Below are other injuries that could happen simultaneously as the ACL tears:

  • Meniscus tears

  • Bone fractures

  • Muscle strains

ACL Diagnosis

First, your physician will discuss your medical history, symptoms, and signs with you. Then, they will review the knee, checking every structure of the injured and non-injured knees. Medical practitioners diagnose many ligament knee injuries with a comprehensive knee physical examination.

Your physician can perform imaging tests to confirm the diagnosis. These tests can include the following:

  • X-rays — While an X-ray will not show your ACL injury, it can help your doctor determine whether your ACL injury is related to your broken bones.

  • Magnetic resonance imaging — An MRI scan produces better and clearer images of soft tissues.

Treating Your ACL Tears

Your treatment will vary depending primarily on your tear grade, among other damage to your knee.

You should avoid engaging in any activity, including sports, that exerts more pressure on the knee. Use the RICE technique once ACL tear symptoms start to manifest. It entails the following:

  • Rest — Avoid all activities that caused the injury. You should not overuse the knee as it recovers

  • Ice — Apply ice packs wrapped in a towel or cold compress to the knee for about fifteen minutes daily

  • Compression — Wrap the knee in a bandage to lower inflammation

  • Elevation — Prop the knee and leg up above your heart level

Your healthcare provider can recommend the following treatment options to manage symptoms like pain:

  • Over-the-counter medication

  • A brace to hold the knee in place — Doctors recommend using knee bracing for a couple of weeks concurrently with your rehabilitation program. The brace restricts the knee’s ROM, protecting your ACL and permitting it to recover.

  • Physical therapy

  • Crutches

While your torn ACL cannot recover on its own, you can live with it. However, if you wish to return to your physical activity or are an athlete, you will require a surgical procedure to repair the ACL.

There are two forms of surgical procedures that your physician can perform on your ACL injuries, namely:

  • ACL repair — ACL ligament tissues are rarely left intact, and the femoral attachment is pulled off. In this case, your doctor can reattach your ACL to your femur.

  • ACL reconstruction — Doctors recommend ACL reconstruction for patients who wish to return to their sporting activities or younger patients. If your tissue is not repairable, your physician should replace it with another tissue to stabilize your knee. The doctor will take graft tissue from a different source to achieve this. It can be donated tissue (allograft) or your tissue (autograft). Since the graft requires remodelling and healing to work like your ligament, you should protect the graft after surgery and engage in physical therapy.

How to Prevent ACL Tear Occurrence

There is little you can do to prevent ACL tears, mainly if you are an athlete. Nobody plans for or expects an accident or sports injury to occur.

You should do the following during your physical activities:

  • Put on proper protective gear

  • Avoid engaging in physical activities after hurting your knee

  • Rest and allow your body to recover following intense activity

  • Engaging in lower body and knee strengthening programs to prepare the knees for the stress that comes with your physical activity

  • Stretch before and after the physical activity.

Here are additional safety tips to lower the risk of sustaining an ACL injury:

  • Avoid pivoting over the knee and planting the foot

  • Ensure your workspace and home do not have clutter that can trip a person

  • Avoid standing on countertops, tables, or chairs to reach things. Instead, utilize the proper equipment

  • Use a walker or cane if you are more vulnerable to falls or have challenges walking

ACL Rehabilitation and Physical Therapy

Physical therapy for ACL is ideal for surgical and conservative options. Conservative treatment for your injuries could be suitable if you are a sedentary patient. Your physical therapist should consider your sporting activities and age when deciding whether you need ACL rehabilitation.

In a physiotherapy program aimed at regaining range of motion (ROM), a program that reinforces and restores standard gait patterns and proprioception is the most effective rehabilitation protocol. Nevertheless, your physician could recommend ACL reconstruction if the knee’s symptomatic instability has not lowered following activity adjustment and physiotherapy. It prevents several interventions due to further cartilage and meniscus damage.

ACL rehabilitation aims to achieve the following goals:

  • Gaining the knee’s full range of motion

  • Repairing muscle proprioception and strength

  • Gaining functional stability

  • Lowering the likelihood of a re-injury

  • Reaching the best functional degree

Here are the different phases of physical therapy:

  • Acute phase

  • Conservative treatment or pre-surgical phase

  • Post-surgical phase

  • Return to sports

Acute Stage

After an injury, physical therapy should focus on regaining range of motion, stability, and proprioception. Your therapist can also work to reduce joint effusion, pain, and swelling, and they can use relevant anti-inflammatory drugs to regulate swelling and pain.

Using crutches and later knee immobilizers could be suitable for some patients. Nonetheless, extended knee immobilizer use could result in quadriceps atrophy and negatively impact ACL strengthening. To help with the preoperative optimization, your physician can recommend the guidelines below:

  • Obtaining full extension by performing exercises like static quads, heel props, passive knee extension, and prone hang exercises

  • Knee flexion in sitting

  • Weight transfer in standing

  • Gluteal exercising in prone

Before Your Surgery

If you undergo a surgical procedure when your knee has limited ROM, is painful, or is swollen, you are more likely to experience knee stiffness. However, you can reduce the risk by delaying your surgery until the pain has subsided and you have obtained your normal ROM.

Your physical therapist can use electrotherapy and RICE weeks before your procedure to help you acquire the full range of motion and reduce joint effusion. Additionally, you should have your normal gait pattern; it is vital to analyze your legs’ motion with one leg when standing and walking. It will help you regain strength and faster motion following your surgery.

The pre-surgical phase can last days or weeks. Your physician should ensure your compliance. Consequently, your rehabilitation should have quantifiable weekly objectives to promote muscular conditioning and strength, gain ROM, and improve proprioception.

Your healthcare provider can offer you two exercise plans at home and in a gym to reinforce your muscular proprioception and strength. Remember to provide your injured ACL with submaximal loads to prevent knee re-injury or swelling due to the absence of proprioception.

Following the Surgical Procedure

Over the years, doctors have used several grafts or tissues to reconstruct ACL tears. Autografts and allografts are the most commonly used graft materials.

You should consider muscular contracture, limited ROM, abnormal gait patterns, and swelling as your indications for obtaining good results. In your after-surgery phase, the factors below are key:

  • Early terminal knee extension equivalent to your contralateral side (It establishes the rehabilitation program’s foundation)

  • Open and closed kinetic chain strengthening exercises

  • Early weight bearing

Return to Sports and Activities

ACL injuries result in functional and static instability that causes changes in motion patterns and a greater risk of developing osteoarthritis. The injury also leads to the premature end of a sporting career.

Power and strength deficits following your surgical procedure could be a risk factor for future injuries. They might set you up for failure when you attempt to return to your previous performance levels. You should return to your favorite sports, provided your surgically treated knee and your uninjured leg perform well.

Before returning to driving your car, you should activate the vehicle’s brake in a simulated emergency. Generally, this should happen around six and three weeks following your right ACL and left ACL recovery.

Before returning to running, you should realize the following:

  • Knee flexion ROM

  • Full extension range of motion

  • No effusion

  • Pain-free alter-G running and aqua jogging

Rehabilitation Exercises for Your ACL Injuries to Start

Rehabilitation exercises can help you regain movement and strength without injuring your ACL further.

Avoid exercises that add weight to or compress your knee. Instead, strengthen the muscles around your knee, including the quadriceps and hamstrings. Strengthening these muscles will gradually extend the range of motion so the knee does not freeze.

While you can do these exercises at home, you require a physical therapist’s input. They can assist you in preparing for your surgical procedure or complement your rehabilitation program.

You should begin the exercises discussed below within a day or two after your surgery and continue for up to four weeks. Remember to pay attention to the sensation in the knee when exercising. If your exercise is painful, stop. You should perform an exercise one to three times daily, provided it does not cause pain.

Ankle Pumps

It entails the following:

  • First, sit or lie on a bed with the feet in front of you

  • Point the feet toward the knee and then point them away from you

  • Alternate the pointing and flexing your feet in every direction

  • Repeat your exercise for approximately three minutes

Heel Slides

Here is how to perform the exercise:

  • Lie on your back with the legs extended and the feet apart

  • Slide the injured leg close to the buttocks

  • Hold the position for about five seconds

  • Slide the heel back to your starting position

Acquire Full Knee Extension Using the Prone Hang Exercise

Knee extension means the knees’ ability to straighten out all the way.

Performing the exercise is seamless at home or your physical therapist’s office. Here is what to do:

  • Lie on your bed on the stomach

  • Slide down on your bed to an edge so the leg hangs over the end. While the bed should support your thighs, the lower leg should hang off your bed.

  • Put a rolled-up towel under the high above the kneecap. It prevents exerting a lot of pressure on the kneecap.

  • You should remain in this position for about a minute and allow gravity to pull the leg towards the floor. This will straighten the knee.

  • Repeat the exercise ten times. Bend your knee to relieve the pressure on the leg before returning to a straight knee position. If you have challenges bending your knee, ask a loved one to help you.

Exercises After Swelling Subsides

Six weeks after your surgery, you will be ready to start your next rehabilitation stage. You can start when:

  • You can stand squarely on all feet without favoring your injured knee

  • You can lift the injured leg in every direction without help

  • You can walk using braces or crutches

  • The inflammation has stopped

If you do not satisfy the criteria above, call a physical therapist to confirm whether you should proceed with the exercises in this phase.

Heel Raises

You should perform this exercise while standing.

  • Begin by placing a hand on a chair’s back for balance

  • Gradually lift the heels and stand on tiptoes for 10 seconds

  • Gradually lower the heels

  • Repeat the process 10 times

Find a Competent Physical Therapist Near Me

An ACL tear is a common knee injury and can occur when a lot of pressure is exerted on the knee while falling on the ground, twisting, or jumping. It can also happen when you suddenly change direction or pivot the knee. Depending on the injury’s severity, your physician can recommend conservative treatment methods or surgery. You will require physical therapy to accelerate your recovery, improve your knee functionality, and alleviate pain, regardless of your treatment option.

At Suarez Physical Therapy, we can work with you to create a personalized plan that can improve your joint function, promote recovery, increase balance, and rebuild muscle strength. We can also help you learn how to lower the stress you exert on the knee via modified movements. Do not let your injury stop you from enjoying your favorite physical activity. Instead, call our Las Vegas office at 702-368-6778 to schedule your medical appointment.