Anterior Cruciate Ligament Injury

The anterior cruciate ligament is one of the main stabilising ligaments of the knee. ACL tears are common and are seen in athletes of all ages and all skill levels.

The majority are non-contact injuries and typically occur when the athlete is twisting, turning or side-stepping with the foot firmly on the ground, especially during football or rugby, or with a poor landing from a jump as in netball and basketball. Skiing injuries occur when the binding fails to release as the ski twists the leg.

Rugby players


At the initial injury, you may hear and feel a distinctive ‘pop’ accompanied by pain and swelling within the hour.

You may also experience instability of the knee with a feeling that it will ‘give way’ particularly when returning to pivoting or twisting activities.

A significant proportion of ACL injuries occur in combination with an additional injury such as a meniscus tear, articular cartilage injury or other ligament injury. Early expert assessment is essential to ascertain the full extent of the injury.


A detailed evaluation of your knee is performed through a series of clinical tests supported by x-rays and a MRI scan. The MRI will also determine if there are any other associated injuries especially as these can affect initial treatment.


The principal objective of treatment is to return you to your desired level of activity without risk of additional injury or damage your knee.

A well-supervised physiotherapy programme is essential for both conservative (non-operative treatment) and surgical treatment.

The primary indication for ACL reconstruction surgery is symptomatic instability. If you wish to return to competitive pivoting sports or have an occupation that demands a stable knee, you may wish to consider early surgery.

Surgery is usually not urgent and is best carried out on a pain free joint with a full range of motion and after a detailed individualised discussion of risks and benefits.


The following downloads will tell you more about ACL injury and treatment options.

Patient leaflet ACL injury and treatment
Physiotherapy leaflet ACL rehabilitation

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