ACL Tear: Diagnosis, Surgery and Recovery

Anterior cruciate ligament (ACL) tears are one of the most feared injuries in the sports world. They affect athletes in all modalities but are particularly common in football, basketball, skiing and contact sports. Dr. Henrique Jones, with over 30 years of experience as physician for the Portuguese National Team, has managed hundreds of ACL reconstruction cases in elite athletes.

What is the anterior cruciate ligament?

The function of the cruciate ligaments is to ensure normal movement between the articular surfaces of the femur and tibia. The anterior cruciate ligament prevents the tibia from sliding forward of the femur and provides rotational stability to the knee.

How does the injury occur?

Approximately 70% of ACL injuries occur during sport. The most frequent mechanism involves:

• Sudden changes of direction with the foot planted on the ground
• Incorrect landing after a jump
• Sudden deceleration
• Direct contact to the knee (less common)

The patient typically feels an audible pop at the time of injury, followed by rapid swelling and inability to continue the activity.

Diagnosis

Diagnosis is based on clinical examination (Lachman and pivot-shift tests) and confirmation by magnetic resonance imaging (MRI), which also allows assessment of associated meniscal and cartilage injuries.

Surgical treatment

ACL reconstruction is performed arthroscopically, using a graft (usually hamstring tendons or patellar tendon) to replace the torn ligament. The arthroscopic technique allows faster recovery with less pain than open surgery.

Rehabilitation programme

Full recovery takes between 6 to 9 months and includes several progressive rehabilitation phases. Return to competition requires rigorous functional assessment including tests of strength, stability and confidence in the operated limb.

The success of ACL reconstruction depends as much on surgical technique as on a careful and progressive rehabilitation programme.