ACL tearing and treatment

ACL tearing and treatment

Anterior cruciate ligament (ACL) rupture in the knee and its treatment

Greetings to you forever friends and companions

In this article, we are going to give you some information about ACL rupture and its treatment in the hope that it will be useful ...

What is ACL?

The ACL (ANTERIOR CRUCIATE LIGAMENT) is the anterior cruciate ligament that moves backward and outward from the anterior tibial bone and connects to the inner part of the latral condyle of femor . The straw is facing forward and rotating outward. The ligament itself is composed of anterior-medial and posterior-outer divisions, which, when knee-flexed, posterior-external, and, if bent, antromedial is tight

Unfortunately, due to the very low blood flow of this ligament, it cannot be repaired and will not be repaired if ruptured.

ACL Injury Mechanism

Contact injuries: account for only 20% of ACL injuries and usually occur directly from the outside of the knee while the knee is slightly bent.

Non-Contact Injuries: 80% of ACL injuries occur and usually occur when jumping out of jump or HYPER EXTENTION.

men and women???

The damage ratio of this ligament in women is 2 to 8 times that of men, among which the following reasons can be mentioned:

Biomechanical factors: such as greater pelvic width in females-knee-jerk-flat foot and ...

Structural factors: such as greater ACL width - thinner INTER CONDYLAR NOTCH

Motion factors: such as landing on a flat knee - less use of hamstring muscle ...

Hormonal Factors:

Symptoms of ACL Injury:

1- Knee swelling less than 2 hours after injury

2. Knee movement restriction

3. Positive special tests

4. giving way

5. Feeling lazy and destabilized

6. Confirmation by radiological findings


Healthy Knee MRI:


Injured Knee MRI:


Anterior cruciate ligament surgical indications:

1. Age under 45 years

2. active patient

3-associated injuries such as miniscule injury, side ligaments, etc.

4. Knee padding and locking

5. Severe knee instability

6. Inflation and chronic pain

Surgery bans:

1.       Age over 45 years

2.       inactivity

3. Do not lock or empty the knee

4. The patient's inability to perform the postoperative rehabilitation process

5. Destructive changes in the knee joint and patella

6. Atrophy and severe muscle weakness

7. Knee Movement Restriction

8. Obesity and BMI greater than 30

9 - Infections

10. Knee aberrations, such as a cruciate knee and a parenthesis knee

Important note:

1. Never Hurry to Undertake This Surgery Note that the condition for successful surgery is proper preoperative physiotherapy. Never undergo surgery despite knee swelling; ROM restriction and muscle weakness.

2. If there is any associated injury, first treat it and then perform a cruciate ligament reconstruction.

3. The interval between injury and surgery should be about 3 to 5 months.

Surgical Techniques:

Arthroscopic technique is used today to repair the cruciate ligament and remove the damaged ligament and replace a graft with screws to the femur and tibia.

This graft can be from the patellar tendon or hamstring, or from the prosthetic, which is more common today with the use of hamstring grafts (semitendinosus-Gracilis).

After and After Surgery:

After surgery, the surgeon performs a Lachman test on the knee to check for correctness, checking the movement of the knee as well as bending the knee 30 times to 0 to 120 degrees to ensure its function. After surgery to prevent swelling and clot formation. And the possibility of embolism using varicose socks for the patient. Antibiotic drugs are prescribed to prevent infection. Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed for a week to reduce pain and swelling. To prevent blood clots, anticoagulants, such as aspirin, are prescribed for 10 days by a physician. The day after the operation, the blood is aspirated into the articular artery, followed by a physiotherapist's visit to the patient, and the patient is given a cane and the necessary recommendations are made. The patient is discharged from the hospital at the discretion of the physician.

Postoperative Exercise Therapy:

The patient is instructed to perform quadriceps and hip muscle contraction as well as ankle pump movement the day after surgery.

Weightbearing: Weightbearing depends on the surgeon's opinion and should be done as directed, but generally the patient should walk for 4 weeks with two canes and 2 weeks with one cane and walk for 6 weeks without a cane.


Research shows that patients who put some weight on their feet immediately after surgery are less likely to develop knee pain than patients who do not lay down for several weeks.

Use of Brace: There are controversial sources about the necessity of using a brace after surgery and thus the use of a brace may depend on the surgeon but should usually be used for up to 6 weeks


Knee range of motion: In the absence of concomitant injury such as a miniscule injury, etc., the knee should be extended in the first week and hyper extension 5 degrees. After the second week the knee should bend 90 degrees. After 4 weeks 120 degrees and after 6 Week 135 degrees.

Knee extension is very important, which should be achieved as soon as possible, usually if the knee is not extended after a full 4 weeks Patient's work resumes surgery.

Effective Knee Extension Exercises:

TOWEL EXERCISE: Put a towel under your ankle so that it is empty under the knee. Do this 6 times a day for 10 minutes each time.

If the knee does not lift after the first week, then the second week should also put weight on the knee, which can increase to 10 kg.


PRONE HANGE: Sleep according to shape so that your ankle is out of bed Apply a thin towel over the patella so that your patella is not disturbed. Stay in this position for 10 minutes.


Effective Knee Bending Exercises:

ROLLING –STOOL EXERCISE: Sit on a wheelchair as you would like and bend your knees forward by doing this 6 times a day for 10 minutes each time.

WALL SLIDE: Lay your foot on the wall in the shape of a foot and let it slide downward.


Using the CPM device is very useful to get the range of motion.


Patellar Movement: Prior to the workout, move the patellar movement in 4 directions inside - outward - up and down and hold for 10 seconds in each position.


Quadriceps muscle contraction: Repeat quadriceps according to the shape of the quadriceps and hold for 10 seconds. Repeat 20 times every 2 hours.

Compare it to the opposite side to see if the contraction is acceptable, or move a good centimeter upwards with a good contraction of the patella.

This should be done from the first day after the operation.


SLR: One week after the operation, you can perform the SLR according to the form and with complete control of the exercise,do it in 4 directions .

The key to doing this exercise is knee lock (EXT LAG) if you are unable to fully lock your knee using a brace.


Weight control can also be used if you have complete movement control. It should be noted that it weighs no more than 10% of your body weight.

Stretching exercises:

The hamstring and twin(gastrocinemius) muscles should be stretched from the first day after surgery.


When rebuilding using a hamstring tendon, keep in mind that your muscle is sensitive and prone to pain and tension. When hamstring stretching, movement should be completely painless.

Gluteal Muscle Strength:

In supine position, contract your muscles and hold this contraction for 10 seconds. Repeat 20 times and do 3 sets.

Hamstring boost:

Shape and press your heels to the ground, hold for 10 seconds and repeat 20 times.


Be careful if you use a hamstring graft to prevent this muscle injury, delay this movement for 4 weeks.

Closed Chain Exercises:

These exercises include squatting against the wall - the terminal knee ext-leg press, and so on. Once you can get 50% of your body weight involved, you can start the exercises.

Stationary bicycle:

After 4 weeks of operation you can start a stationary bike first start with low resistance and gradually increase resistance and speed. Set the bike chain high altitude early.



Walking in water can start after 4 weeks if the quadriceps muscle is strong enough.

Be careful about the floor of the pool as it is likely to slip.


Balance exercises:

Without exaggeration, balance exercises are the most important part of the treatment and not more important than strengthening the muscles; not least.

From the first week you can do weight shift with a cane and a blindfold.

As soon as the crutch is lifted, one-leg stand exercises and, if possible, blindfold Do the package.

After 6 weeks the balance board exercises begin.


Twin Muscle Strength:

After four weeks, you should strengthen this muscle as you see fit.


Strengthening the muscles around the hip:

SLR movement in 4 directions also strengthens the muscles around the hip, which you can do in a few days with a stretch.

Strengthening of these muscles can be done after 4 weeks with HIP MACHINE.



After 6 weeks, the hamstring can be reinforced with the device.



Quadriceps muscle strengthening in the open chain can be done after 6 weeks.


It is important to note that quadruple reinforcement should not be performed in full range for up to 3 months and should only be strengthened between 90 and 45 degrees.


You can start running 18 weeks after the operation. All of the following conditions must be met to start running:

1.No Knee pain and swelling

2. Not knee brace

3. Quadriceps force 70% opposite

4. The range of motion of the knee is complete

5. The difference in the amplitude of the instability shall not be more than 3 mm

Back to sports activities:

If the following conditions are met after 6 months you can return to your sport activity:

1.No Knee pain and swelling

2. Not knee brace

3 - Difference of instability less than 3 mm

4. Quadriceps force 90% opposite

5. 100% hamstring strength on the opposite side

6. Hamstring to Quadripses ratio over 70%

7. Pass the balance and functionality tests

All of these procedures should be performed by a dedicated knee physiotherapist.

Let us know your questions ...

Hoping for a painless life for

 physiotherapist Alireza Sepehri