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Anterior Cruciate Ligament (ACL) Tear
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is the Anterior Cruciate Ligament (ACL)?
The Anterior Cruciate Ligament (ACL) is a tissue that connects the thigh bone to the shinbone and controls the front and back motion of the knee. It provides rotational control and stability by limiting forward movement of the thigh bone on the shin bone. Without an intact ACL, the knee may feel loose and wobbly.
An ACL tear is a common knee injury that occurs during sports with sudden twisting motions and changes in direction. When the ACL tears, the anterior cruciate ligament sprains or splits from the bone attachments.
What Are ACL Tear Symptoms?
When you tear your ACL, you may hear a popping sound. Other symptoms may follow, such as:
- Swelling in the knee
- Pain and tenderness at the joint
- Loss of full range of motion
- A feeling of instability, especially when weight is put on the joint
What Causes An ACL Tear?
It is more common for ACL tears to occur during sports activities when the knee is vulnerable to injury. Certain movements can cause an ACL tear including:
- Sudden change in direction
- Suddenly stopping
- Landing from a jump
- Getting into an impactful collision directly on the knee
Sports such as soccer, basketball and tennis have a higher risk of tearing the ACL.
What Are The Risk Factors Of An ACL Tear?
While anyone can injure their knee and experience an ACL tear, certain factors may increase the risk of the ligament injury. These include:
- Female
Women tend to tear their ACL more often than men, and this may be due to differences in muscle conditioning, anatomy and strength. - High-risk sports
Participating in certain sports like basketball, soccer, skiing, and volleyball requires movements that could tear the ACL. - Previously torn ACL
A torn and treated ACL has a higher risk of re-tearing.
How Do You Prevent An ACL Tear?
Even though ACL tears are common, they can be prevented through strength training and learning good exercise techniques. Some examples include:
- Strengthening the core muscles
- Practising proper landing techniques
- Strengthening leg muscles
- Good warm-up practices
What Should You Do If You Think You Have Torn Your ACL?
If you suspect you have torn your ACL, stop all physical activities and keep weight off your leg by sitting down. Make an appointment immediately with your orthopaedic specialist or medical provider. Keep your leg raised above chest level until then, and ice the area if you notice swelling. Refrain from putting pressure on your knees and take over-the-counter pain medication to manage the discomfort.
How Is An ACL Tear Diagnosed?
An ACL tear is typically diagnosed through a combination of physical examination, patient history, and imaging tests. Initially, your orthopaedic specialist will assess the knee’s stability, swelling, and range of motion. They may perform specific maneuvers, such as the Lachman test, to check the integrity of the ACL.
Accessing how the injury occurred and the symptoms experienced are also crucial for a preliminary diagnosis. To confirm the extent of the tear and to rule out damage to other knee structures, magnetic resonance imaging (MRI) scans are often utilized. In some cases, X-rays might be ordered to exclude bone fractures. This comprehensive approach ensures an accurate diagnosis, which is essential for determining the most effective treatment plan.
What Are The Grades Of An ACL Injury?
An ACL injury is classified into a three-class grading system that signifies the severity of the injury. Grade 1 injuries are the least severe, while Grade 3 injuries are the most severe. Depending on the grade, treatment for the ACL tear may vary.
- Grade 1
The ligament is slightly stretched but not torn and can still maintain the knee’s stability. - Grade 2
The ligament is partially torn and loose. - Grade 3
The ACL is completely torn and split into two, making the knee unstable.
What Are The Complications Of An ACL Tear?
An ACL tear can increase the risk of developing knee osteoarthritis even after surgical treatment. It is also possible for the joint cartilage to deteriorate, and the range of motion may be minimised.
What Happens If A Torn ACL Goes Untreated?
Not all ACL injuries require surgical treatment. Grade 1 ACL tears are usually treated with physical therapy and immobilisation.
However, if a torn ACL goes untreated, it may lead to:
- Bleeding and blood clots that can worsen the condition
- Ongoing severe pain
- Weakness in the knees
- Reduced mobility
It is important to make an appointment with an orthopaedic specialist to understand the best treatment plan for your ACL injury.
How Is An ACL Tear Treated?
Depending on the severity of the injury, your age, and activity level, the treatment for an ACL tear may vary. There are both non-surgical and surgical treatment options to fix ACL tears.
Non-surgical Treatment
Non-surgical treatment is usually recommended for patients with a partial ACL tear and no instability or painful symptoms. A non-surgical option may also be given to patients who are older or live a less active lifestyle.
Non-surgical treatments include:
- Physical therapy & rehabilitation
- Knee brace support
Surgical Treatment
Surgery is recommended for athletes who want to return to their sport or if the ACL is completely torn and other ligaments are injured, causing significant discomfort. Young children with ACL tears are also recommended to opt for surgical treatment, as delayed treatments can lead to more cartilage injuries in the future.
ACL reconstruction is done through a knee arthroscopy and requires a graft to replace the torn ACL. This graft can be harvested from the patient’s own hamstring or patellar tendon. Alternatively, a graft can also be taken from a tissue donor. After the surgery, crutches or a walking aid should be used in the first 2-4 weeks, and a knee brace is required in the first 6 weeks.
Patients will also undergo regular rehabilitative therapy after the procedure to restore strength and stability in the injured knee.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
What Is The Cost Of ACL Surgery In Singapore?
According to MOH’s fee guideline, knee arthroscopy ACL surgery costs an average of $30,000 at a private hospital. This fee is calculated before deducting your personal insurance plans (Integrated Shield Plans, Medishield Life) and MediSave payouts. The maximum MediSave payout you can obtain for a knee arthroscopy is $3,950.
Dr Kau (许医生) is on the panel for most major local insurers. Talk to our team and your insurance agent to understand the out-of-pocket fees required for a knee arthroscopy.
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Frequently Asked Questions (FAQs)
Do ACL tears cause permanent damage?
If an ACL tear is not treated, it can lead to the loss of joint function in the future.
Can an ACL tear heal on its own?
A complete ACL tear cannot heal on its own and requires surgery. If the ACL tear is less severe, it is still important to consult an orthopaedic specialist for a recommended non-surgical treatment plan.
How long does an ACL injury take to heal?
After an ACL reconstruction surgery, recovery can take 9 months.