Understanding the injury, symptoms, treatments and rehabilitation
The sprain of anterior cruciate ligament (ACL) This is one of the most common and feared knee injuries, especially among athletes. It can occur in both elite athletes and amateur players, and its consequences can be significant if not properly managed. Understanding this injury is essential for tailoring treatment, optimizing recovery, and minimizing the risk of long-term problems.
What is the anterior cruciate ligament?
The anterior cruciate ligament is one of the four main ligaments of the knee. Located in the center of the joint, it connects the femur At tibia and crosses the posterior cruciate ligament, hence its name.
Its role is fundamental:
- It prevents the tibia from sliding excessively forward.
- It participates in the control of rotational movements.
- It stabilizes the knee during changes of direction and braking.
Without a functional ACL, the knee loses some of its stability, which exposes it to sensations of "giving way" and secondary injuries.
What is an ACL sprain?
An ACL sprain occurs when trauma results in a abnormal stretching or rupture of the ligamentUnlike other ligaments, the ACL heals very poorly spontaneously when it is ruptured.
We typically distinguish between:
- a mild sprain (simple stretching),
- moderate sprain (partial tear),
- severe sprain (complete rupture).
In the majority of clinically significant cases, it is a complete rupture.
Causes and mechanisms of ACL sprain
ACL sprains occur most often without direct contact, during a poorly controlled movement. The most frequent mechanisms are:
- a sudden rotation of the knee with the foot fixed on the ground,
- an off-balance landing from a jump
- a rapid change of direction,
- a sudden deceleration.
Sports most affected
- soccer,
- alpine skiing,
- handball,
- basketball,
- rugby,
- pivot or contact sports.
Factors such as fatigue, muscle weakness, or poor coordination can increase the risk.
Symptoms of an ACL sprain
Symptoms usually appear immediately:
- acute pain at the time of the trauma
- a sensation of cracking or tearing,
- Rapid swelling of the knee (hemarthrosis)
- difficulty gaining support
- impression of instability.
In some cases, the pain decreases rapidly, which can lead to underestimating the severity of the injury.
Diagnosis: How to confirm an ACL sprain?
The diagnosis is based on several stages:
- Clinical examination
- Stability tests (Lachman, anterior drawer, pivot shift)
- Medical imaging
- MRI : the gold standard examination to confirm the rupture and look for associated injuries (meniscus, cartilage)
- X-ray: useful for ruling out an associated fracture
The different degrees of ACL sprain
| Degree | Description |
|---|---|
| Minor sprain | Stretching of the ligament without rupture |
| moderate sprain | Partial rupture |
| severe sprain | Complete ACL rupture |
Complete rupture is the most frequent situation in sports injuries.
Possible treatments
Non-surgical (functional) treatment
Indicated in certain cases:
- patients who are not very athletic
- absence of bothersome instability,
- good muscle tone.
It is based on:
- rest and initial icing,
- intensive physiotherapy,
- muscle strengthening (quadriceps, hamstrings),
- adaptation of physical activity.
Surgical treatment: ligamentoplasty
Often recommended for:
- regular athletes,
- young and active patients,
- people suffering from persistent instability.
The surgery consists of rebuild the ACL using a graft (patellar tendon or hamstring tendon).
Rehabilitation and return to sport
Rehabilitation is a key stepwhether or not there is surgery.
Main objectives
- recovery of joint range of motion,
- muscle strengthening,
- proprioceptive work
- prevention of relapses.
The time before resuming sport generally varies from 6 to 12 months, depending on the patient's activity and progress.
What are the long-term consequences?
Without proper treatment, an ACL sprain can lead to:
- chronic knee instability
- Secondary meniscal lesions,
- early osteoarthritis of the knee,
- sustained limitation of physical activity.
This is why medical monitoring and rehabilitation are crucial for the prognosis.
Living with an ACL sprain on a daily basis
A sprain of the anterior cruciate ligament does not only have sporting consequences: it also impacts the daily lifeSometimes, this can occur as early as the first few days following the injury. Walking may become unsteady, especially on stairs, uneven terrain, or when changing direction. This feeling of instability is often described as the knee "giving way," leading to apprehension and a loss of confidence.
In the acute phase, routine activities should be adaptedRelative rest, avoiding risky movements, and, if necessary, temporarily wearing a knee brace help to stabilize the joint. Resuming driving, work, or prolonged travel depends on the pain, swelling, and stability of the knee. Physically demanding jobs or those involving frequent travel may require a longer period of sick leave or temporary adjustments to work arrangements.
Prevention: can the risk be reduced?
Yes, several measures have proven effective:
- neuromuscular prevention programs,
- targeted strengthening of the lower limbs
- improvement of sports technique,
- structured warm-up before exertion.
These strategies are particularly recommended for young athletes.
Conclusion
An anterior cruciate ligament sprain is a serious knee injury that requires a precise diagnosis and one appropriate care to the patient's profile. Whether treated functionally or surgically, the rehabilitation plays a central role in recovery and prevention of long-term complications. Early and well-managed treatment allows, in most cases, for the restoration of good knee stability and a return to physical activity under good conditions.
