ACL Tears

An ACL tear occurs when the ligament is overstretched or torn due to excessive force. This injury is common in athletes who participate in sports that involve rapid acceleration and deceleration, cutting maneuvers, and jumping with sudden landings. Soccer, basketball, football, and downhill skiing are among the most frequent sports associated with ACL injuries.

ACL tears can be classified into:

• Partial tears: The ligament is stretched and damaged but not completely torn.
• Complete tears: The ligament is fully ruptured, leading to significant instability in the knee.

A severe ACL tear often requires surgical reconstruction, as the ligament does not heal on its own due to limited blood supply. In some cases, non-surgical management with physical therapy and bracing may be considered for older patients or those with lower activity levels. However, for athletes and active individuals, ACL reconstruction is often necessary to regain full function and prevent long-term complications like osteoarthritis.

When an ACL tear occurs, it is often accompanied by co-occurring injuries, particularly damage to the meniscus, cartilage, or other ligaments in the knee. More than half of people with an ACL tear also have a meniscus tear.

An ACL tear can cause immediate and significant symptoms, including:

• A loud “pop” sound at the time of injury, which is often audible to both the person affected and those nearby.
• Severe pain in the knee, making it difficult or impossible to continue activity.
• Rapid swelling within the first few hours after the injury due to internal bleeding in the joint.
• Instability or a “giving out” sensation, particularly when attempting to bear weight on the injured leg or change direction.
• Loss of range of motion, making it difficult to fully extend or bend the knee.

While these symptoms strongly suggest an ACL tear, a proper medical evaluation is necessary to confirm the diagnosis and determine the extent of the injury.

ACL tears occur when the ligament is subjected to forces beyond its normal range of motion. Some of the most common causes include:

• Sudden stops or changes in direction: A sharp pivot or cut while running can place excessive strain on the ACL.
• Direct impact to the knee: Collisions, such as those seen in football, can force the knee into an unnatural position, leading to ligament damage.
• Landing awkwardly from a jump: Sports that require frequent jumping, such as basketball or volleyball, can increase the risk of ACL injury if the knee absorbs too much impact or twists upon landing.
• Hyperextension of the knee: Overextending the knee joint, often seen in skiing accidents, can put excessive stress on the ACL.
• Weakness or imbalance in leg muscles: Insufficient strength in the quadriceps or hamstrings can contribute to instability and make the knee more vulnerable to injury.

Women are at a higher risk of ACL tears compared to men, likely due to differences in biomechanics, muscle strength, and hormonal influences that affect ligament elasticity.

A thorough evaluation by an orthopedic knee specialist like Dr. David Gazzaniga at Newport Orthopedic Institute is essential for accurately diagnosing an ACL tear. The process typically includes:

Medical History and Symptom Review

Dr. Gazzaniga will ask how the injury occurred, the symptoms the patient is experiencing, and whether they heard a popping sound at the time of injury.

Physical Examination

Specific tests help assess the stability of the ACL and determine if it has been torn. These tests involve manual manipulation of the knee to check for abnormal movement.

Imaging Tests

• MRI is the most reliable imaging tool for detecting ACL injuries. It provides detailed images of soft tissues, allowing Dr. Gazzaniga to assess the severity of the tear and check for additional damage to the meniscus or cartilage.
• X-rays may be performed to rule out fractures but cannot detect ligament injuries.

Early and accurate diagnosis is crucial for determining the best course of treatment, whether it be conservative management for minor injuries or surgical intervention for complete tears. Dr. Gazzaniga, an expert in sports medicine and orthopedic surgery, provides comprehensive evaluation and personalized treatment plans for patients with ACL injuries, helping them return to their active lifestyles as safely and effectively as possible.