ACL Tears: Symptoms, Risks, and Treatment Options

Q: ACL Tears: Symptoms, Risks, and Treatment Options

Hello： According to your description, it seems that the anterior cruciate ligament (ACL) has transitioned from a tear to a rupture. <br>In medical terminology, both a tear and a rupture refer to the same condition, with the distinction being whether it is a partial (single bundle

Anterior cruciate ligament tear

Ten days ago, I was playing basketball and landed on one foot, twisting my left knee.
A few hours later, it swelled up, and I experienced weakness and pain while walking.
I can’t bend my knee beyond 90 degrees without pain.
I had an MRI, which showed a torn anterior cruciate ligament (ACL) and a bone contusion.
Then, a couple of days ago, I had a calf cramp while sleeping, and in a reflex action, I suddenly pulled my foot to a 180-degree angle, causing intense pain in my knee that woke me up.
At that moment, my knee hurt so much that I couldn’t straighten my leg, and it took a while to relax.
The pain felt similar to the injury I sustained while playing basketball, and I also felt a sharp pain deep inside my knee.
Now, the swelling in my knee is similar to what it was before the cramping incident.
I still can’t fully extend my knee when walking, and I feel a sharp pain inside my knee that sometimes radiates to my buttocks, resembling nerve pain.

I would like to know if this incident while sleeping could cause the previously torn ACL to completely rupture.
I’m very concerned that it might fully tear.
If it does tear completely, what symptoms should I expect? Will there be additional bleeding and increased swelling? Also, I had been using heat therapy for the past seven days.
Does this mean I have re-injured it? Should I switch to ice therapy for the next two days?

Niming, 20~29 year old female. Ask Date: 2021/09/10

Dr. You Dianqi reply Orthopedics

Hello: According to your description, it seems that the anterior cruciate ligament (ACL) has transitioned from a tear to a rupture.
In medical terminology, both a tear and a rupture refer to the same condition, with the distinction being whether it is a partial (single bundle) or complete (double bundle) rupture.
More concerning is the possibility of a meniscus tear, which may have been present at the time of your injury or could be a new injury.
I recommend that you discuss this further with your attending physician to evaluate the ACL, especially during movements that involve sudden stops, rapid changes in direction, or twisting, as these actions may highlight the difference in the ACL's integrity.
Since there is swelling now, I suggest applying ice.
I hope for your speedy recovery.

Reply Date: 2021/09/10

More Info

Understanding ACL (Anterior Cruciate Ligament) tears is crucial for anyone involved in sports or physical activities, especially those that involve jumping, pivoting, or sudden changes in direction. An ACL tear can significantly impact mobility and quality of life, so it's essential to recognize the symptoms, risks, and treatment options available.

Symptoms of ACL Tears
The symptoms you are experiencing align with a typical ACL injury. Common symptoms include:
1. Swelling: This often occurs within a few hours of the injury, as you've noted. The swelling is due to fluid accumulation in the knee joint.

2. Pain: Pain is usually felt in the knee area, particularly during movement or when trying to bear weight. The pain can be sharp and may feel like a "popping" sensation at the time of injury.

3. Limited Range of Motion: As you've described, difficulty bending the knee beyond 90 degrees and straightening it fully is a common symptom.

4. Instability: Many individuals report a feeling of instability or that the knee may "give way" during activities.

5. Muscle Spasms: The calf cramps you experienced could be a response to the injury, as the body tries to protect the knee.

Risks of Further Injury
Regarding your concern about whether further movement or reflex actions during sleep could worsen the ACL tear, it is indeed possible. If the ligament is partially torn, excessive movement can lead to a complete tear. Symptoms of a complete tear may include:
- Increased swelling and pain
- A feeling of instability in the knee
- Difficulty walking or bearing weight
- A popping sound at the time of injury
- Bruising around the knee
If the ligament completely tears, you may also experience more significant swelling and pain, and the knee may feel unstable. It is essential to monitor these symptoms closely.

Treatment Options
1. Initial Care: For the first few days post-injury, the RICE method (Rest, Ice, Compression, Elevation) is recommended. Since you mentioned using heat, it would be wise to switch to cold therapy (ice packs) for the next 48 hours to reduce swelling and numb the pain. After that, you can alternate between heat and cold as needed.

2. Physical Therapy: Once the initial swelling decreases, physical therapy can help restore strength and stability to the knee. A physical therapist can guide you through exercises tailored to your recovery.

3. Surgical Options: If the ACL is completely torn, surgical intervention may be necessary, especially if you are active in sports. The surgery typically involves reconstructing the ligament using a graft from another tendon.

4. Rehabilitation: Post-surgery, a structured rehabilitation program is crucial for recovery. This will involve gradual strengthening and range-of-motion exercises.

Conclusion
Given your symptoms and the MRI results indicating an ACL tear, it is crucial to follow up with an orthopedic specialist. They can provide a comprehensive evaluation and recommend the best course of action based on the severity of your injury. Avoid any activities that may exacerbate the injury until you receive professional guidance. Early intervention can significantly improve your recovery outcomes and help you return to your desired activities safely.

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