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Everything You Need to Know About Anterior Cruciate Ligament (ACL) Injury

Dr Dutton - Anterior Cruciate Ligament - Orthopaedic Singapore
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It can be discouraging to experience an injury interrupting your active lifestyle as an adult. It can be worse for athletes who need agility and endurance to perform their routines. An anterior cruciate ligament (ACL) injury is one of the most feared injuries. It can stop you from doing activities you love, keep you out of the gym and off the sports field and prevent you from achieving your fitness goals.

Whether you have been affected by a torn ACL or want to know more to prevent a possible injury, this blog post has all the information and advice you need. From identifying symptoms of an ACL tear and exploring potential non-surgical options for recovery to understanding what rehabilitation looks like, we have you covered after the surgery.

What is an ACL injury?

To form the knee joint, three bones meet — the femur (thighbone), tibia (shinbone), and patella (kneecap). These bones are connected by four primary ligaments, which act like strong ropes to keep the bones intact. The primary ligaments include:
  • Medial collateral ligament (MCL).
  • Lateral collateral ligament (LCL).
  • Anterior cruciate ligament (ACL).
  • Posterior cruciate ligament (PCL).

An injury to any of these ligaments causes severe pain and swelling. For example, one of the most common injuries to the knee ligaments is an anterior cruciate ligament (ACL) injury. Typically, this injury is caused by the overstretching or tearing of the ligament, which can be partial or complete.

Tears on the ACL are one of the most common knee injuries. In the United States, about 200,000 people experience ACL injuries, half needing reconstructive surgery. A study conducted in Singapore revealed that ACL tears are more prevalent among males and those overweight. Further, most injuries were reported in sports settings.

ACL injuries are relatively common in many countries, especially among athletes and individuals who participate in sports that involve jumping, cutting, and pivoting movements. The incidence of ACL injuries among athletes varies depending on the sport and level of play, with higher rates reported in sports such as soccer, basketball, and skiing.

Causes of ACL injury

An ACL injury typically involves a sudden twisting or deceleration movement that causes the ACL to stretch or tear. This can happen due to a direct impact to the knee, such as a collision during a sport, or a non-contact injury, such as planting the foot and quickly changing direction.

When the ACL is stretched or torn, it can no longer adequately control the movement of the thigh bone in relation to the shinbone. This can result in instability, pain and swelling in the knee, as well as difficulty bearing weight or participating in physical activities.

  • Medial collateral ligament (MCL).
  • Lateral collateral ligament (LCL).
  • Anterior cruciate ligament (ACL).
  • Posterior cruciate ligament (PCL).
Aside from the major causes of ACL injuries, some people are more likely to have them than others. The risk factors include:
  • Female
  • Hormonal changes in women
  • Weak knee muscles
  • Individuals who have had a previous knee injury
  • Lack of physical conditioning
  • Muscle fatigue
  • Poor body mechanics

ACL injury signs and symptoms

The symptoms of an ACL injury can vary depending on the severity of the injury, but some common signs include the following:
  • A popping or tearing sound at the time of injury
  • Pain and swelling in the knee, which may develop within a few hours of the injury
  • Difficulty bearing weight on the affected leg
  • Instability or a feeling of the knee “giving way.”
  • Difficulty straightening the knee
  • Loss of range of motion in the knee
  • Bruising and tenderness on the knee
  • A sense of the knee being “unstable” or “wobbly.”

Diagnosis of ACL injury

When you experience any signs and symptoms, you must seek medical attention immediately. This way, a proper diagnosis will be given. First, the doctor will perform a physical examination, including testing for stability and swelling in the knee. Your range of motion and ability to bear weight will also be checked. The doctor may also recommend imaging tests such as an MRI (magnetic resonance imaging) or X-ray may also be used to confirm the diagnosis and assess the extent of the injury.

ACL injury treatment

The treatment of an ACL injury depends on the severity of the condition and the patient’s activity level. The doctor may prescribe two types of treatment options — surgical and non-surgical.

Non-surgical treatment

Rice, ice, compression, elevation (RICE). Resting the knee, applying ice, compressing the knee with an elastic bandage, and elevating the knee while sitting can help reduce pain and swelling.

Medicines. Over-the-counter pain medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and inflammation in the knee.

Physical therapy. This can help improve flexibility, strength, and stability in the knee. It can also help prevent future injuries.

Bracing. Wearing a knee brace or support helps give extra support to the knee and reduces stress on the ACL.

These remedies aid in alleviating symptoms, but they are not a substitute for professional medical treatment. First, you need to consult an orthopaedic surgeon to assess and determine the severity of the injury. From there, the doctor will devise a treatment plan tailored to your needs.

Surgical treatment

Surgical options include ACL reconstruction, which replaces the torn ligament with a tissue graft. This is the most widely used treatment for ACL injuries. It’s often recommended for patients who are active in sports and other high-impact activities.

Keyhole surgery is often prescribed for athletes who use their knees for sporting activities, such as football, basketball, or volleyball. In this type of surgery, a tiny camera about 5mm wide guides the surgeon into the affected ligament. This lessens the risk of infection since it’s minimally invasive compared to open surgery. During the procedure, the doctor will pump fluid into the knee to stretch it out and allow for a better view. Then, to reconstruct the ligament, the surgeon will graft a tendon taken from the patient’s hamstring or the patella.


How does it take to recover from ACL surgery?

The recovery time after an ACL injury can vary depending on the severity of the condition, the patient’s overall health status, and the type of treatment received. For those who underwent surgical treatment, you will likely need to adhere to a rehabilitation program that includes exercises, physical therapy, and other treatments to restore stability, strength, and flexibility in the knee.

The recovery time may be shorter for those who do not need surgery, but in some cases, it can take several months. To help hasten the recovery, physical therapy and rehabilitation exercises are necessary.

It’s important to remember that recovery is a long process, and it can take time to regain full strength of the knee to return to your activities, especially for athletes. Returning to sports and other high-impact activities depends on your doctor’s advice and recovery progress.

What are the side effects and risks of surgery?

Though ACL surgery is a common procedure and considered generally safe, like any surgery, it does come with some side effects and risks, including:

Pain and swelling. After surgery, it’s common to have pain and swelling. It can come with stiffness, lasting for weeks or even months. See your doctor if you’re experiencing severe pain or if the pain medicines prescribed are not working.

Infection. Another risk of any surgery is infection. Though the risk is low in ACL surgery because the incision is smaller, report any signs such as fever, swelling, or pus.

Graft or implant failure. In some cases, the grafts placed to repair the torn ligament may fail or be rejected by the body.

Re-injury. Even though ACL surgery can improve the strength and stability of the knee, the patient may still be at risk of re-injuring it if they return to high-impact activities too soon or fail to follow the proper rehabilitation protocol.

Why choosing an experienced doctor is important.

The knee is a crucial part of the musculoskeletal system, enabling you to move freely and perform the activities you enjoy. That is why choosing an experienced doctor for ACL surgery is essential when it gets injured.

Proficiency with surgery. The doctor has years of experience and training in dealing with ACL surgery. They have performed several surgeries in the past. Further, they are well-versed in modern and up-to-date surgical techniques and technologies, which can help increase the chances of positive outcomes.

Knowledge of complications. The surgeon who is trained and experienced with ACL surgery is knowledgeable in potential complications of the surgery. Hence, they know how to manage and handle them if they occur.

Post-surgery follow-up. The surgery will not end after the procedure, but the surgeon must have a follow-up plan and rehabilitation program tailored for you. An experienced surgeon has been trained in performing post-surgery follow-ups.

Rehabilitation knowledge. An experienced surgeon will have a good understanding of the rehabilitation process. They will provide guidance and support during the recovery period.

The Takeaway

ACL injuries can be devastating for athletes and non-athletes alike. Therefore, it is vital to understand the risks, symptoms, and treatment options if you are dealing with an ACL injury or are at risk for one. But with the proper treatment and rehabilitation program, you can return to your previous activity levels.

Remember, it’s crucial to find a doctor with a good track record of performing ACL surgeries and ask for referrals from other patients or your primary care doctor. It’s also important to feel comfortable with the doctor and to have open communication with them about your concerns and questions.

We hope this article has provided everything you need about ACL injuries. If you want to learn more or have questions about your case, book a consultation with A/Professor Andrew Dutton by calling us at (+65) 6836 8000. We would be happy to provide further guidance and support.

A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance

The A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic offers minimally invasive and surgical treatments for sports-related injuries and orthopaedic conditions.

To aid in the expenses that you may incur, we accept a number of corporate and international insurance. If you have any of the insurance plans below, please let us know when you book an appointment with us. If you need further assistance, you may drop us an e-mail at or call us at (+65) 6836 8000.

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About A/Professor Andrew Quoc Dutton

A/Professor Dutton, also known as, has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. A/Professor Dutton has worked at the Prince of Wales Hospital, Sydney, and the St. George Hospital, Sydney, before completing his orthopaedic surgery training in Singapore. He is currently an associate professor of orthopaedic surgery at the National University of Singapore (NUS).

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