Anterior Cruciate Ligament (ACL) Tear Symptoms and Surgery Process

An anterior cruciate ligament (ACL) tear is the rupture of the main connective tissue that keeps the knee stable, usually resulting from a sudden twist or strain. Often signaling its presence with a distinct popping sound from the knee, severe pain, and rapid swelling, this injury is particularly common during weekend astroturf football matches or sports requiring sudden changes in direction. It makes walking quite difficult by creating a sensation that the knee is giving way.

• A "pop" or snapping sound from the knee is the most typical initial symptom.
• Noticeable swelling and an increase in warmth occur in the knee within the first 24 hours.
• A definitive diagnosis is made through a physical examination by an orthopedic specialist and an MRI scan.
• Surgical intervention (arthroscopy) is generally preferred for young and active individuals.
• The process of returning to sports after surgery takes an average of 6 to 9 months.

What is an Anterior Cruciate Ligament (ACL) Tear?

The knee joint consists of four main ligaments connecting the thigh bone (femur) to the shinbone (tibia). The anterior cruciate ligament is the most critical structure preventing the knee from sliding forward and providing rotational stability to the joint. An ACL tear occurs when this tissue exceeds its stretching capacity, partially or completely losing its integrity. It is frequently seen in sports requiring sudden stops and directional changes, such as football, basketball, and volleyball.

The recent spotlight on professional football injuries has once again shown how common this condition is. However, it can happen not only to professionals but to anyone playing amateur sports or leading an active life. In Türkiye, weekend astroturf football matches (halı saha) pose a significant risk for knee ligament injuries, often due to a lack of proper warm-up and the artificial turf surface. When this ligament—one of the knee's main weight-bearing pillars—tears, a severe sense of instability arises in the joint, making even daily movements challenging.

Causes and Risk Factors

Knee ligament injuries typically occur without a direct external blow, driven instead by the person's own body weight and movement. Stopping suddenly while running, twisting the knee while the foot is firmly planted, or landing awkwardly after a jump are the most common causes of a tear. Sudden directional changes to bypass an opponent while playing football or basketball abruptly increase the load on the ligament, leading to a rupture.

Insufficient muscle strength ranks high among risk factors. When the front thigh (quadriceps) and back thigh (hamstring) muscles are not strong enough, the load on the knee is transferred directly to the ligaments. Furthermore, playing sports on hard or slippery surfaces like artificial turf, or wearing inappropriate cleats or shoes, significantly increases the risk. Female athletes have a higher risk of ACL injuries compared to males due to anatomical structure, muscle strength imbalances, and hormonal differences. Fatigue is also a major factor; as muscles tire toward the end of a match or training session, knee stability weakens, paving the way for injuries.

Anterior Cruciate Ligament Tear Symptoms

The symptoms experienced in the knee at the moment of injury are quite typical and severe. Most patients report hearing a clear popping or snapping sound from inside the knee when the injury occurs. This sound is often accompanied by a feeling that the knee has popped out of joint and slid back into place. Within the first few hours, rapid and prominent swelling develops due to bleeding inside the joint. The pain is usually intense, and the person has great difficulty putting weight on the injured leg.

In the first few days following the tear, the following symptoms stand out:

• Severe pain, tenderness, and sensitivity to touch in the knee.
• Significant restriction in the joint's range of motion; inability to fully bend or straighten the knee.
• A feeling of the knee giving way or instability when trying to walk.
• Increased warmth around the knee and bruising that appears in the following days.

As the acute phase passes and swelling subsides, the pain may ease. However, the feeling of instability in the knee is permanent. The knee suddenly giving way while walking down stairs or making a sharp movement is the clearest indicator that the ligament has lost its function. At this stage, consulting a specialist to plan treatment is essential.

How is it Diagnosed at the Hospital?

When you visit the hospital suspecting an ACL tear, the orthopedic physician first listens closely to how the injury happened. A comprehensive physical examination is then performed, comparing the injured knee with the healthy one. The doctor applies specific manual examination tests called Lachman and Pivot Shift. In these tests, the shinbone is pulled forward to measure the ligament's resistance; if the bone moves forward more than normal, it strongly indicates a torn ligament.

Imaging methods are necessary for a definitive diagnosis and to identify any accompanying injuries. Initially, an X-ray is taken to rule out any fractures in the knee. While X-rays do not show ligaments, they clearly reveal the bone structure. The gold standard method for a detailed view of the ligaments, menisci, and cartilage tissue is Magnetic Resonance Imaging (MRI). Through an MRI, it can be definitively determined whether the tear is partial or complete, if there is bone bruising (edema), and whether additional damage, such as a meniscus tear, is present.

Treatment and ACL Surgery Process

The treatment plan is shaped by the patient's age, activity level, and the extent of the knee damage. The first response after the injury begins at home: resting the leg, applying ice for 15 minutes every hour, applying compression with an elastic bandage, and keeping the leg elevated above heart level helps control swelling. For active athletes, young individuals, or patients with a severe feeling of emptiness in the knee, the standard treatment is ACL reconstruction surgery.

Surgical intervention is generally performed using a minimally invasive method called arthroscopy. In this procedure, a camera and special surgical instruments are inserted through tiny incisions at the front of the knee. Because the torn ligament cannot simply be stitched back together, a new tissue taken from the patient's own body (usually the hamstring muscle tendons at the back of the knee) is grafted into place. The surgery takes about one to one and a half hours.

The postoperative rehabilitation process is just as critical as the surgery itself. Crutches are used in the first few weeks, and physical therapy begins immediately. Patients typically return to daily life within 3 to 4 weeks, start light jogging by the 3rd month, and return to competitive sports between 6 to 9 months. Strengthening the muscles is vital for the adaptation of the new ligament.

Complications and Risk Groups

Untreated ACL injuries or neglected rehabilitation processes can lead to permanent knee problems. Because the knee's stability is compromised when the ligament tears, the bones rub against each other more than normal. This paves the way for the tearing of the menisci—the knee's shock absorbers—and premature wear of the cartilage. In later years, this wear leads to the development of osteoarthritis, commonly known as joint calcification. If signs of osteoarthritis have begun, supportive methods like PRP and Intra-Articular Injection Treatments for Knee Osteoarthritis can be considered upon your doctor's recommendation.

There are also certain risks in the postoperative period. Joint stiffness and restricted movement may develop in patients who do not fully comply with the physical therapy program. Furthermore, returning to sports too early before muscle strength is fully regained can result in the re-rupture of the newly implanted graft. Therefore, athletes, young people, and those working in physically demanding jobs constitute the risk group that needs to be most careful during the treatment process.

When to See a Doctor?

After experiencing a sudden twist or sprain in your knee, certain symptoms require immediate medical attention. It may not always be easy to distinguish a simple strain from a severe ligament tear. However, seeking medical help at a healthcare facility without delay directly impacts the healing process and prevents further damage to the knee.

You should consult an orthopedic specialist or visit the emergency room without delay if you experience any of the following symptoms:

• Hearing a clear popping or snapping sound from the knee at the moment of injury.
• Inability to bear weight on the knee or the knee giving out after taking a few steps.
• Rapid swelling and tightness in the knee within the first few hours.
• A visible deformity in the kneecap or around the joint.
• Numbness, tingling, or coldness in the leg, ankle, or toes (this may indicate vascular or nerve damage; you should immediately call 112 or go to the emergency room).

Diagnosis and Treatment Process at BHT CLINIC

Rapid and accurate intervention in knee injuries is the fundamental step to preventing permanent damage. At our BHT CLINIC İstanbul Tema Hospital Orthopedics and Traumatology department, current medical approaches in sports injuries and joint surgery are meticulously applied. For sudden injuries you might experience during weekend astroturf matches or evening training sessions, our 24/7 emergency department and advanced radiology unit ensure a swift diagnosis.

Bringing any previous X-ray or MRI results with you when visiting our hospital speeds up the process. We are by your side at every stage of your healing journey with our expert physician staff, modern operating room equipment, and our physical therapy unit, which is of great importance in the postoperative period. To evaluate your condition and create the most appropriate treatment plan for you, you can book an appointment via the BHT CLINIC website or reach us continuously through our call center at 0850 811 34 00.

Frequently Asked Questions

Can an ACL heal without surgery?

A completely torn anterior cruciate ligament cannot heal or fuse back together on its own. However, in older patients with low activity levels, a non-surgical life can be maintained by strengthening the muscles through intensive physical therapy.

When can I walk after surgery?

You can stand up and start walking with the support of crutches the very next day after surgery. Usually, crutches are set aside within 3 to 4 weeks, and a normal walking pattern is resumed.

What should I do first at the moment of a tear?

At the moment of injury, you should immediately stop the activity and avoid putting weight on your leg. You should apply ice to your knee, elevate your leg above heart level, and visit a healthcare facility as soon as possible.

Can a torn ligament be diagnosed without an MRI?

An expert orthopedic physician can largely determine that the ligament is torn through specific physical examination tests. However, an MRI is mandatory for a definitive diagnosis and to see any accompanying meniscus tears.

How long does it take to return to professional sports?

A full return to professional or competitive sports after ACL surgery takes an average of 6 to 9 months. This timeframe can vary depending on the patient's compliance with the physical therapy program and the speed of muscle strength recovery.

This article is for informational purposes only; please be sure to consult your physician for diagnosis and treatment.