ANTERIOR CRUCIATE LIGAMENT INJURY OVERVIEW

The anterior cruciate ligament (ACL) is an important stabilizing ligament in the knee. It is frequently
injured by athletes and trauma victims; in the United States alone, there are between 100,000 and
200,000 ACL tears per year.
This topic review will discuss the causes, signs and symptoms, diagnostic tests, and treatment options for
ACL injuries.
WHAT IS THE ANTERIOR CRUCIATE LIAGMENT (ACL)?
The knee joint is held tightly together by four ligaments: the inner and outer fan-shaped hinge ligaments
(medial and lateral collateral ligaments) and the crossing (cruciate) ligaments, which sit in the middle of
the joint (the anterior and posterior cruciate ligaments) (figure 1).
The collateral ligaments are firmly attached to the far end of the femur (thigh bone) and the near end of
the tibia and fibula (lower leg bones). The ligaments hold the two bones together and prevent side to side
motion. The anterior cruciate ligament prevents forward and backward motion. You can partially or
completely tear the ligament(s).
Other structures can be damaged during an acute ACL injury, including:

The meniscus

Joint capsule (the tissue that surrounds the joint)

Articular cartilage (cartilage that covers the ends of bones where they meet in a joint)

The ends of the femur or tibia

Other ligaments (medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior
cruciate ligament (PCL)) (figure 2)

One common injury is called the athlete's triad, in which the ACL, MCL, and medial meniscus are all torn.
CAUSES OF ANTERIOR CRUCIATE LIGAMENT INJURY
Non-contact ACL injuries typically occur when a person is running or jumping and then suddenly slows
and changes direction (eg, cutting) or pivots in a way that involves rotating or bending the knee sideways.
Women appear to be at a higher risk of non-contact ACL injuries than men, although the exact reason for
this is not clear [1].
Contact-related ACL injuries usually occur from a direct blow causing hyperextension or when the knee is
forced inwards towards the other leg. This is often seen in American football when a player's foot is
planted and an opponent strikes him on the outside or front of that thigh.
ACL injuries most commonly occur during the following activities:

Noncontact sports, such as downhill skiing, gymnastics, and tennis

Certain contact sports, including rugby, American football, soccer, and basketball

Motor vehicle collisions

ANTERIOR CRUCIATE LIGAMENT INJURY SYMPTOMS

People who have an ACL injury often complain of feeling a "pop" in their knee at the time of injury and
have a feeling the knee is unstable or "giving out." Within a few hours of the ACL injury, nearly everyone
develops swelling in the knee, caused by bleeding from injured blood vessels; this is called an effusion.
After the initial swelling has improved, most people are able to bear weight but feel unsteady on the
affected knee. Movements such as squatting, pivoting, and stepping sideways, and activities such as
walking down stairs, in which the entire body weight is placed on the affected leg, can cause the feeling of
unsteadiness.
ANTERIOR CRUCIATE LIGAMENT INJURY TESTS
Anyone who experiences a knee injury and subsequently has pain, swelling, and/or feels unsteady while
standing should be evaluated by a healthcare provider. The provider will perform a physical examination.
An imaging test may be recommended to examine the bones and ligaments.
ANTERIOR CRUCIATE LIGAMENT INJURY TREATMENT
ACL injuries are treated with surgery and post-surgical rehabilitation or a non-surgical rehabilitation
program. The decision to have surgery is based upon several factors, including the person's age, level of
activity, and the presence of other knee injuries [2].
A person is likely to choose to have surgery if he or she:

Participates in high-level sports or has a job that requires a strong and stable knee (eg, requires
twisting and pivoting)

Is unsteady when standing on the injured knee

Has multiple injuries

Has completed rehabilitation and still has instability in the knee

Is willing to complete the rigorous post-surgical rehabilitation program. Most programs require
daily strengthening and stretching exercises and one or more weekly visits with a physical
therapist for the first three to six months after surgery. (See 'Post-surgical rehabilitation' below.)
Failure to follow this program could increase the risk of re-injury, allow scar tissue to develop, and
lead to limited movement of the knee.

A person may decide not to have surgery if he or she:

Has a small partial tear in the ACL that may heal with rest and rehabilitation

Does not participate in sports that require pivoting or stopping quickly, especially if the person is
older than 55 years

Is willing to complete a non-surgical rehabilitation program to strengthen and stabilize the knee
(see 'Non-surgical rehabilitation' below)

If the ACL is not reconstructed, there may be an increased risk of future knee problems, including chronic
pain, a decreased level of activity, and injury to other parts of the knee (the meniscus) [3].
Presurgical rehabilitation Surgery is not usually performed immediately after an ACL injury because
this could cause excessive scar tissue (arthrofibrosis) to develop, which would limit knee motion. In most
cases, surgery is delayed until the swelling has resolved and the person is able to bend and straighten
the knee without difficulty. Using ice packs and elevating the knee above the chest can help to reduce
swelling. The time between an ACL injury and surgical reconstruction depends upon how quickly the
person recovers.
During the time between the injury and the surgery, many surgeons recommend a "pre-habilitation"
exercise program to help reduce pain and swelling, improve range of motion (the ability to flex and extend
the knee), and increase strength in the muscles of the thigh, knee, and hip. Walking, bike riding, and
swimming (with light kicks and no breast stroke) can be continued, although other sports should be
avoided.
An example of a presurgical rehabilitation exercise program is detailed below. (See 'Non-surgical
rehabilitation' below.)
Surgery After the ACL is torn, it is not possible to repair the ligament. This is due to several factors,
including a damaged blood supply to the ligament (blood vessels damaged during injury) and cells inside
the synovial fluid (normal fluid in the knee), that prevent healing. Research is underway to determine how
to repair the tendon, but the only way to repair the ACL currently is to reconstruct it.
Surgical reconstruction of the ACL is usually done in a hospital or surgical center. Most people are given
general anesthesia to induce sleep and prevent pain. The surgery itself usually takes less than two hours.
To reconstruct the torn ligament, a piece of healthy tendon, called an autograft, is "harvested" from
another area in the leg. There are several common autograft sites, including the patellar tendon,
hamstring tendon, or rarely the quadriceps tendon (figure 3). Another option is to use a tendon from a
deceased donor, called an allograft. No one type of graft has been proven to be better than another. Thus,
the type of graft that is used depends upon the surgeon's preference and experience.

Patellar autograft When harvesting a patellar autograft, an extra incision is made in the skin to
remove a strip of tendon with a piece of bone at each end. The graft site usually heals quickly and
regains normal strength. Some people have soreness in this area for several months after
surgery, especially if pressure is applied to the area (eg, while kneeling).

Hamstring autograft If using a hamstring autograft, there are no extra incisions needed and
the pain at the harvest site is usually less than that seen with a patellar autograft. Hamstring
strength usually returns to normal within three to six months.

Allograft Allografts do not require any extra incisions, and there is no risk of pain or weakness
at the site of graft harvest.

The torn ACL is removed and replaced with the graft using a narrow telescope-like device, called an
arthroscope. The scope contains a camera and light source, and can be inserted into the knee joint
through a small skin incision. Instruments are inserted into other small incisions, allowing the physician to
place the graft with precision. After the graft is secured, the knee is wrapped with sterile dressings and an
immobilizer is placed around the knee to allow the person to walk more easily with crutches.
Most people are able to go home after spending several hours in the recovery room; it is not usually
necessary to spend the night. A machine that moves the knee through a range of motions, called a
continuous passive motion (CPM) machine, will be used immediately after surgery, and then sent home
with the patient. CPM helps to prevent the development of scar tissue. A prescription for pain medications
is given to relieve pain at home. Most people visit their surgeon one to two weeks after surgery.
During the first few days after surgery, the goal is to control swelling and pain. Elevating the knee above
the chest and applying ice to the knee are the best ways to do this. Most people use crutches to assist
with walking for the first seven to 10 days after surgery, although most patients are encouraged to begin
bearing weight on the affected leg as soon as possible. If more extensive surgery is performed, the
surgeon may recommend delaying weight bearing for a longer period. Stretching and strengthening
exercises can usually begin within the first few days after surgery.
Potential complications Most people do well after ACL reconstruction and have no major
complications. However, complications occasionally occur during surgery or during the rehabilitation
period. The most common complications include:

Bleeding into the joint (effusion)

Joint infection

Blood clot in the deep veins of the leg (deep vein thrombosis)

Arthrofibrosis (scar tissue)

Loosening of the graft

ANTERIOR CRUCIATE LIGAMENT INJURY REHABILITATION

Rehabilitation is a several month long program that is designed to stretch and strengthen the knee after
ACL reconstruction or injury. No one program is best for all people, although the following exercises are
one example of a program that may be recommended.
Non-surgical rehabilitation If surgery is not planned, rehabilitation can help to reduce the risk of
further injury. Rehabilitation should begin as soon as swelling and pain begin to improve. Use the
stretching and strengthening exercises listed below at least once per day for four to six weeks. These
exercises are also recommended as a pre-surgical rehabilitation program.

These exercises may cause some discomfort but should not cause significant pain, especially after the
exercise session is over. If pain is severe or continues after resting and icing the knee, contact a
healthcare provider.

Assisted knee flexion Sit on the floor with the legs extended in front of the body. Place the
hands behind the injured thigh, bend the knee and pull it towards the chest, keeping the back
straight (picture 1). Hold for five seconds then straighten leg. Repeat 10 to 15 times (one set).
Perform a total of three sets.

Assisted knee flexion

Sit on the floor with the legs extended in front of the body. Place the hands behind the
injured thigh, bend the knee and pull it towards the chest, keeping the back straight.
Hold for 5 seconds then straighten leg. Repeat 10 to 15 times (one set). Perform a total
of 3 sets.

Quad sets Sit on the floor with the legs extended in front of the body. Place the hands behind
the affected knee. Keep the leg straight and contract the quadriceps muscle (just above the
knee), which should cause the knee cap to move towards the body (picture 2). Hold for a count of
10 seconds. Release and rest as needed. Repeat 10 to 15 times (one set). Perform a total of
three sets.

Quad sets

Sit on the floor with the legs extended in front of the body. Place the hands behind the
affected knee. Keep the leg straight and contract the quadriceps muscle (just above the
knee), which should cause the knee cap to move towards the body. Hold for a count of 10
seconds. Release and rest as needed. Repeat 10 to 15 times (one set). Perform a total of
3 sets.

Straight leg raises Lie on a bed or the floor. Bend the "good" knee and keep the foot on the
floor. Keep the injured leg straight. On the injured side, tighten the quadriceps (as above), keep
the leg straight, and lift the leg about 18 inches off the floor (picture 3). Slowly lower the leg back
to the bed or floor. Rest as needed. Repeat 10 to 15 times (one set). Perform a total of three sets.

Straight leg raises

Lie on a bed or the floor. Bend the "good" knee and keep the foot on the floor. Keep the
injured leg straight. On the injured side, tighten the quadriceps (as above), keep the leg
straight, and lift the leg about 18 inches off the floor. Slowly lower the leg back to the bed
or floor. Rest as needed. Repeat 10 to 15 times (one set). Perform a total of 3 sets.

Calf raises Stand behind a chair, holding onto the chair. Slowly rise up and stand on the balls
of the feet and toes (picture 4). Hold for five seconds then slowly roll down onto the entire foot.
Rest as needed. Repeat 10 to 15 times (one set). Increase the difficulty of this exercise by rising
higher, holding longer, or moving up and down more quickly. Perform a total of three sets.

Calf raise

Stand behind a chair, holding onto the chair. Slowly rise up and stand on the balls of the feet and
toes. Hold for 5 seconds then slowly roll down onto the entire foot. Rest as needed. Repeat 10 to
15 times (one set). Increase the difficulty of this exercise by rising higher, holding longer, or
moving up and down more quickly. Perform a total of 3 sets.

Hip extension You will need 18 to 24 inches of rubber tubing or an elastic band (eg,
Theraband) to perform these exercises. Secure the tubing around the leg of a heavy piece of
furniture or close it in a door. Stand facing the furniture/door and place the injured leg in the loop
of the tubing. You should not have any slack in the tubing. Hold the door/furniture and extend the
injured leg backwards, stretching the tubing as far as possible (picture 5). Hold for five seconds.
Slowly return the leg to the floor. Rest as needed. Repeat 10 to 15 times (one set). Perform a
total of three sets.

Hip extension

You will need 18 to 24 inches of rubber tubing or an elastic band (eg, Theraband) to
perform these exercises. Secure the tubing around the leg of a heavy piece of furniture or
close it in a door. Stand facing the furniture/door and place the injured leg in the loop of
the tubing. You should not have any slack in the tubing. Hold the door/furniture and
extend the injured leg backwards, stretching the tubing as far as possible. Hold for 5
seconds. Slowly return the leg to the floor. Rest as needed. Repeat 10 to 15 times (one
set). Perform a total of 3 sets.

Hip abduction As above, you will need a piece of rubber tubing or elastic band. Stand with the
legs shoulder width apart, with the "good" leg closest to the furniture or door. The tubing should
loop around the outside of the injured leg. Lift the affected leg to the side, 18 to 24 inches away
from the body, stretching the tubing (picture 6). Hold for five seconds, then slowly release. Rest
as needed. Repeat 10 to 15 times (one set). Perform a total of three sets.

Hip abduction

As above, you will need a piece of rubber tubing or elastic band. Stand with the legs shoulder
width apart, with the "good" leg closest to the furniture or door. The tubing should loop around
the outside of the injured leg. Lift the affected leg to the side, 18 to 24 inches away from the
body, stretching the tubing. Hold for 5 seconds, then slowly release. Rest as needed. Repeat 10
to 15 times (one set). Perform a total of 3 sets.

Stretching and strengthening should then continue as discussed below. (See 'Second phase' below.)
Post-surgical rehabilitation Most people who have ACL reconstruction will be under the care of a
surgeon and physical therapist who will work together to design a rehabilitation program. The following
rehabilitation schedule is an example of one that may be recommended.\

Presurgical exercises (See 'Non-surgical rehabilitation' above.)

Quarter squats Stand 18 to 24 inches from a wall. Lean back against the wall. Bend both knees slightly
(the buttocks should not be lower than the knees), keeping the back straight (picture 7). Hold for five
seconds then slowly stand up straight. Rest as needed. Repeat 10 to 15 times (one set). Perform a total
of three sets. To increase the difficulty, bend the knees more deeply, hold for a longer time, and increase

the speed.

Quarter squat

Stand 12 to 18 inches away from a wall (facing away from the wall). Place feet shoulder-width
apart. Lean back against the wall and slide the back down the wall while bending the knees. Do
not bend the knees more than 30 to 45 (this should not hurt the knees). Hold for a count of 5.
Stand up. Repeat 10 times.

Alternately, use an exercise ball to perform squats. Stand up straight, holding the ball between
your back and the wall. Slowly bend the knees and lower the back (roll the ball down the wall).
Hold for a count of five. Stand up. Repeat 10 to 15 times.

Bridges Lie on your back on the floor. Keep the feet on the floor and bend both knees. Place
the hands about 12 inches to the side of the body (on the floor). Lift the buttocks six to eight
inches off the floor (picture 8). Hold for five seconds, then slowly release. Rest as needed.
Repeat 10 to 15 times (one set). Perform a total of three sets.

Bridges

Lie on your back on the floor. Keep the feet on the floor and bend both knees. Place the
hands about 12 inches to the side of the body (on the floor). Lift the buttocks 6 to 8
inches off the floor. Hold for 5 seconds, then slowly release. Rest as needed. Repeat 10 to
15 times (one set). Perform a total of 3 sets. To increase the difficulty, keep the right foot
on the floor and lift the left foot off the floor, keeping the left leg straight. Raise the
buttocks using the right foot to support the lower body. Switch sides. Repeat 10 to 15
times (one set). Perform a total of 3 sets.

To increase the difficulty, keep the right foot on the floor and lift the left foot off the floor, keeping
the left leg straight. Raise the buttocks using the right foot to support the lower body. Switch
sides. Repeat 10 to 15 times (one set). Perform a total of three sets.

Single-leg calf raises Stand behind a chair, holding onto the chair. Lift the "good" foot off the
floor so that you are standing on the injured leg. Slowly rise up and stand on the ball of the foot
and toes (picture 9). Hold for five seconds then slowly roll down onto the entire foot. Rest as
needed. Repeat 10 to 15 times (one set). Increase the difficulty of this exercise by rising higher,
holding longer, or moving up and down more quickly. Perform a total of three sets.

Single-leg calf raises

Stand behind a chair, holding onto the chair. Lift the "good" foot off the floor so that you
are standing on the injured leg. Slowly rise up and stand on the ball of the foot and toes.
Hold for 5 seconds then slowly roll down onto the entire foot. Rest as needed. Repeat 10
to 15 times (one set). Increase the difficulty of this exercise by rising higher, holding
longer, or moving up and down more quickly. Perform a total of 3 sets.

Step ups Use a stair climber or steps, step up first with the injured leg. Continue for 10 to 15
minutes per day.

Balance Use a wobble board or balance disk to improve knee strength and balance ability.
If a wobble board or balance disk is not available, try balancing on the affected leg while lifting the
unaffected leg off the ground; do not hold onto any support (picture 10). Hold this position for a
count of five to 10. Rest and repeat 10 to 15 times. To increase the difficulty, raise the unaffected
leg into the air.

Balance

Use a wobble board or balance disk to improve knee strength and balance ability. If a
wobble board or balance disk is not available, try balancing on the affected leg while
lifting the unaffected leg off the ground; do not hold onto any support. Hold this position
for a count of 5 to 10. Rest and repeat 10 to 15 times. To increase the difficulty, raise the
unaffected leg into the air.

Phase three During the fourth to sixth months after surgery, the difficulty and intensity of the exercises
described above should be continued. In addition, exercises that include jumping and landing can be
started.

Lunge Stand with the feet together. Step the right foot approximately 36 inches in front of the
body. The right knee should be over the right ankle and the left calf should be parallel to the floor
(picture 11). Hold for five seconds. Step the right foot back so that the feet are together. Rest as
needed. Repeat with the left leg. Repeat 10 to 15 times (one set). Perform a total of three sets.

Lunge

Stand with the feet together. Step the right foot approximately 36 inches in front of the
body. The right knee should be over the right ankle. Hold for 5 seconds. Step the right
foot back so that the feet are together. Rest as needed. Repeat with the left leg. Repeat
10 to 15 times (one set). Perform a total of 3 sets.

Some activities may be resumed at this point, including jogging in a straight line, swimming (kick lightly),
and biking on the road. As strength and ability improve, running and other activities can be restarted as
well.
Prognosis Most people who have surgical reconstruction of the ACL have a good outcome and are
usually able to return to all of their previous activities by six months after surgery. Athletes can return to
sports once their reconstructed knee demonstrates strength and balance roughly equal to the uninjured
knee. This generally occurs within 6 to 12 months, depending upon the sport and the person's dedication
to the rehabilitation program.
There are no studies that address the risk of reinjury after ACL reconstruction. When ACL reconstruction
is done properly, there should be no increased risk of ACL reinjury

First phase During the first two weeks after surgery, the goal is to increase range of motion (flexing
and extending the knee), maintain strength, minimize the development of scar tissue, and eliminate
swelling. Most people begin to walk without crutches by the end of the first week. The knee should be
iced and elevated daily to minimize swelling.
Exercises during this phase should include those discussed above. (See 'Presurgical
rehabilitation' above.)
Second phase Between the third and twelfth weeks after surgery, the goal is to improve range of
motion, strength, walking, and balance. Most people are allowed to walk or use an exercise bike for 15 to
20 minutes per day. When possible, walking or running in a pool with a floating belt can be helpful. The
following exercises may also be recommended.

Presurgical exercises (See 'Non-surgical rehabilitation' above.)

Quarter squats Stand 18 to 24 inches from a wall. Lean back against the wall. Bend both
knees slightly (the buttocks should not be lower than the knees), keeping the back straight
(picture 7). Hold for five seconds then slowly stand up straight. Rest as needed. Repeat 10 to 15
times (one set). Perform a total of three sets. To increase the difficulty, bend the knees more
deeply, hold for a longer time, and increase the speed.
Alternately, use an exercise ball to perform squats. Stand up straight, holding the ball between
your back and the wall. Slowly bend the knees and lower the back (roll the ball down the wall).
Hold for a count of five. Stand up. Repeat 10 to 15 times.

Bridges Lie on your back on the floor. Keep the feet on the floor and bend both knees. Place
the hands about 12 inches to the side of the body (on the floor). Lift the buttocks six to eight
inches off the floor (picture 8). Hold for five seconds, then slowly release. Rest as needed.
Repeat 10 to 15 times (one set). Perform a total of three sets.
To increase the difficulty, keep the right foot on the floor and lift the left foot off the floor, keeping
the left leg straight. Raise the buttocks using the right foot to support the lower body. Switch
sides. Repeat 10 to 15 times (one set). Perform a total of three sets.

Single-leg calf raises Stand behind a chair, holding onto the chair. Lift the "good" foot off the
floor so that you are standing on the injured leg. Slowly rise up and stand on the ball of the foot
and toes (picture 9). Hold for five seconds then slowly roll down onto the entire foot. Rest as
needed. Repeat 10 to 15 times (one set). Increase the difficulty of this exercise by rising higher,
holding longer, or moving up and down more quickly. Perform a total of three sets.

Step ups Use a stair climber or steps, step up first with the injured leg. Continue for 10 to 15
minutes per day.

Balance Use a wobble board or balance disk to improve knee strength and balance ability.
If a wobble board or balance disk is not available, try balancing on the affected leg while lifting the

unaffected leg off the ground; do not hold onto any support (picture 10). Hold this position for a
count of five to 10. Rest and repeat 10 to 15 times. To increase the difficulty, raise the unaffected
leg into the air.
Phase three During the fourth to sixth months after surgery, the difficulty and intensity of the exercises
described above should be continued. In addition, exercises that include jumping and landing can be
started.

Lunge Stand with the feet together. Step the right foot approximately 36 inches in front of the
body. The right knee should be over the right ankle and the left calf should be parallel to the floor
(picture 11). Hold for five seconds. Step the right foot back so that the feet are together. Rest as
needed. Repeat with the left leg. Repeat 10 to 15 times (one set). Perform a total of three sets.

Some activities may be resumed at this point, including jogging in a straight line, swimming (kick lightly),
and biking on the road. As strength and ability improve, running and other activities can be restarted as
well.
Prognosis Most people who have surgical reconstruction of the ACL have a good outcome and are
usually able to return to all of their previous activities by six months after surgery. Athletes can return to
sports once their reconstructed knee demonstrates strength and balance roughly equal to the uninjured
knee. This generally occurs within 6 to 12 months, depending upon the sport and the person's dedication
to the rehabilitation program.
There are no studies that address the risk of reinjury after ACL reconstruction. When ACL reconstruction
is done properly, there should be no increased risk of ACL reinjury.
ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION
Numerous organizations, including the American Academy of Orthopaedic Surgeons and the American
College of Sports Medicine, agree that programs to prevent ACL injury are beneficial for female athletes
[4]. Many experts also believe that any athlete who is at high-risk for an ACL injury (eg, American football
players, skiers) should participate in a prevention program.
An analysis of ACL injury prevention programs noted the following:

Programs that incorporated high-intensity jumping exercises reduced injury rates.

Programs that analyzed athletes movements and provided direct feedback about proper
positioning and movement reduced injury rates.

Programs that incorporated strength training reduced injury rates, although strength training alone
did not.

Balance training alone is unlikely to reduce injury rates, although it may enhance other prevention
techniques.

Athletes must participate in prevention training at least two times per week for a minimum of six
consecutive weeks to accrue benefit.

Prevention programs are usually tailored to a particular sport and should initially be taught and supervised
by a knowledgeable athletic trainer, physical therapist, or comparable professional
(http://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST%20ACL%20Injury%2008.pdf).
Use of external braces or other devices has not been shown to reduce the risk of ACL tears and is not
recommended for prevention.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your
medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for
patients, as well as selected articles written for healthcare professionals, are also available. Some of the
most relevant are listed below.
Patient level information UpToDate offers two types of patient education materials.
The Basics The Basics patient education pieces answer the four or five key questions a patient might
have about a given condition. These articles are best for patients who want a general overview and who
prefer short, easy-to-read materials.
Patient information: Anterior cruciate ligament tear (The Basics)
Patient information: Knee pain (The Basics)
Beyond the Basics Beyond the Basics patient education pieces are longer, more sophisticated, and
more detailed. These articles are best for patients who want in-depth information and are comfortable with
some medical jargon.
Patient information: Knee pain (Beyond the Basics)
Patient information: Total knee replacement (arthroplasty) (Beyond the Basics)
Professional level information Professional level articles are designed to keep doctors and other
health professionals up-to-date on the latest medical findings. These articles are thorough, long, and
complex, and they contain multiple references to the research on which they are based. Professional level
articles are best for people who are comfortable with a lot of medical terminology and who want to read
the same materials their doctors are reading.

Recovering from an anterior cruciate ligament

reconstruction
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the
patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
You can also apply ice packs, for example, frozen peas wrapped in a towel, to your knee to help reduce any pain and
swelling. Don't apply ice directly to your skin as it can damage your skin.

It usually takes about six months to make a full recovery from ACL reconstruction but this varies between individuals,
so it's important to follow your surgeon's advice. If you have a desk job, you may be able to go back to work three to
four weeks after your operation. It may take up to six months if you have an active job.
If you want to play sport after your operation, follow your surgeons advice about when its safe to do so. You may not
be able to play some sports that involve lots of twisting and turning, for example basketball