An ACL rupture is often a defining knee injury that can cause considerable distress to athletes. It can suddenly occur during a pivot, landing or collision and is often followed by pain, swelling and a loss of trust in the knee.
Early assessment is important to confirm the diagnosis, understand the wider injury pattern and plan a way forward.
The anterior cruciate ligament (ACL) is one of the key stabilising ligaments within the knee. It helps control the forward movement of the shin bone beneath the thigh bone and plays an important role in rotational control.
The ACL is central to the knee’s ability to pivot, twist and change direction – movements essential to sports and to many daily activities.
Melbourne Knee Centre’s approach to these injuries is informed by Mr Nathan White’s high-level subspecialty training in knee surgery and his Fellowships at Fortius Clinic and in Football Medicine with Chelsea Football Club.
An ACL rupture typically occurs when the knee twists over a firmly planted foot. Interestingly, it often happens during a routine maneuver an athlete has performed countless times before. However, a subtle change (such as a light bump or an unexpected shift in balance) can cause the knee to enter a vulnerable position. In that split second, the leg’s protective reflexes are bypassed, and the force passing through the joint simply exceeds what the ligament can withstand, causing it to snap.
ACL rupture is common in sports involving landing and pivoting, including football, netball, soccer and rugby. It can also occur through contact, particularly when the knee is forced out of position in a collision.
An ACL rupture is often accompanied by other injuries, including meniscal (cartilage) tears and other ligament strains, such as PCL and MCL injuries.
There are a wide range of experiences following ACL injury. If you’ve ruptured your ACL:
Diagnosis begins with a careful history, imaging, and a clinical examination.
An MRI is commonly used to confirm the ACL rupture and assess the rest of the knee, including the menisci, cartilage, bone bruising and surrounding ligaments. This is an important step because many ACL ruptures are associated with meniscal or cartilage damage, which can affect both treatment planning and the long-term health of the knee.
An ACL rupture does not always require immediate surgery. The KANON study of young active patients found that about one-third of ruptured ACLs may display evidence of healing on MRI when patients are managed with rehabilitation alone, and those signs can show as soon as 3 months after injury.
The location of the tear appears to influence whether the ACL can heal without surgery. Tears that occur at the upper end of the ligament, closer to the thigh bone, may have a greater tendency to heal naturally. The ACL’s healing potential may also be affected by age (the patients in the KANON study were aged 18-35) and whether the torn ends of the ligament remain close enough together for the body’s repair processes to bridge the gap.
For many patients, we may trial a period of non-operative management, using a structured rehabilitation protocol to see whether the knee heads towards stable function.
However, if the knee remains unstable, or if you’re likely to place high demands on it, reconstruction may be the most reliable way to improve function. At Melbourne Knee Centre, we take the time to work through those factors carefully before recommending a course of action.
As an exclusive knee practice, ACL management is one of Melbourne Knee Centre’s core offerings, informed by advanced sports medicine experience in Australia and overseas.
Our experienced surgeons understand the debilitating and distressing nature of ACL ruptures, especially for high-performance athletes. We are adept at assessing injuries in a timely manner, providing advice and reassurance, and developing a comprehensive treatment plan informed by the latest evidence.
Alongside surgery, we provide an integrated rehabilitation pathway, either in our clinic or in liaison with local or club physiotherapists.
Melbourne Knee Centre prioritises early assessment for athletes with time-sensitive sporting injuries. Our surgeons can review scans, provide initial advice on management and create a plan for treatment and return to sport.
We aim to accommodate urgent referrals quickly, and encourage you to call our rooms on 03 9853 5981.