Anterior Cruciate Ligament (ACL)

The anterior cruciate ligament (ACL) is one of four major ligaments of the knee. ACL injuries are common in sports that involve sudden changes of direction, such as football and soccer, but they can also occur during regular daily activities. 

More than 400,000 ACL injuries occur every year in the United States in active people and athletes. Often, the injury can lead to long-term problems in stability and degeneration. 

When the ACL is injured, the pain can be excruciating -- or minor -- but the result is debilitating. If you have -- or suspect you have -- an ACL injury, we can help. 

We treat all forms of ACL stretches, tears and ruptures successfully because of our years of experience and our multidisciplinary approach to ACL treatment. We have extensive experience with children and have treated ACLs in infants. We involve all areas of our health care team in assessing your condition -- and getting you better and fully functioning as soon as possible. 

We have experience with all ACL graft options, including autographs (tissue transfer from your body) and allographs (tissue transfer from a donor) and can advise you on the best choice for you depending on your age and activity level. 

If your meniscus is injured, the sooner you are treated, the more likely a repair (not removal) will be possible. If your meniscus is removed when you are a teenager, your risk of getting arthritis at an early age skyrockets. We are experts at meniscus repair. 

Note: If you have suffered a trauma -- whether it's from a fall or a sports injury -- it's important to seek treatment as soon you can, or you could risk further complications such as stiffness, prolonged pain or scar tissue in the joint. Getting that diagnosis quickly and accurately means we can treat you while the injury is simpler to treat. 

Symptoms 

Some people have minimal to no pain, minimal swelling and feel like they could play, but be careful. 

The typical symptoms of an ACL tear or injury include:

  • A loud popping sound at the moment of injury
  • Inability to bear weight on your leg
  • Instability
  • Severe knee pain at the moment of the injury and more pain when you try to stand
  • Swelling

Diagnosis 

When you come to the University of Michigan:

  • We will take your medical history, ask you about your pattern of symptoms and conduct a clinical exam.
  • Most ACL tears (more than 95%) can be diagnosed during a physical exam -- your exam may require x-rays
  • We may order an MRI to see if there is additional damage to bone, cartilage or menisci.

Then we will use all of this information to develop an individualized treatment plan for you. 

Treatment

Non-surgical Treatment for an ACL Injury

Small ACL stretches or tears may require a brace and/or physical rehabilitation. We work closely with the experts in our Rehabilitation area to give you a plan of treatment that will eliminate pain, stabilize your joint and prevent further damage. Partial tears may not require surgery if a lifestyle change is acceptable. 

Surgery for an ACL Injury

We consider non-surgical treatments first, but if the tear is complete and the knee is unstable, or the knee doesn't heal with non-surgical treatment, surgery may be necessary. The ACL cannot heal on its own because there is no blood supply to this ligament. Surgery is usually required for athletes because the ACL is needed in order to safely perform the sharp movements that are required in sports. 

We are very experienced in the three major types of ACL reconstructive surgery that are done arthroscopically by inserting a specially designed illuminated scope into the joint through a small incision:

  • Patella tendon-bond autograft - With this surgery, we remove the central one-third of the patella tendon along with a piece of bone at the attachment sites at the kneecap and tibia. 
  • Hamstring autograft - We take two tendons from the hamstring muscles and wrap them together to form the new ACL. 
  • Quadriceps tendon grafts - These grafts are excellent for revision surgery, pediatric ACL tears and PCLs. 
  • Grafts - We do both allografts (in which we use a donor tissue from a tissue bank) and autographs (in which we would use your hamstring tendon or the middle third of your patella tendon). 

We also do partial and full knee replacements when necessary. 

Before and after surgery, you will benefit greatly from rehabilitation to strengthen the muscles surrounding your ACL, stabilize your knee joint, reduce swelling and increase range of motion. If surgery is performed before you regain full range of motion and swelling is reduced, it can be difficult to get back to normal after surgery. We will work closely with our excellent Rehabilitation team to develop a treatment plan just for you. 

Contact Us / Make an Appointment

  • MedSport, 877-877-9333, or 734-930-7400
  • Orthopaedics, 734-936-5780
  • Physical Medicine and Rehabilitation (PMR), 734-936-7175

Selecting a health care provider is a very important decision. Because we are highly experienced in successfully treating ACL tears and other knee injuries, we would like to help you explore your options. Visit our Contact Us page to see a list of Musculoskeletal Call Centers. Our staff will be glad to talk with you about your options and how we can help.