The ACL, or anterior cruciate ligament, is one of four major ligaments providing stability to the knee joint. An injury to this important structure is commonly associated with athletic activity. The injury often occurs as a result of jumping and pivoting, and often without any contact from an opposing player. An athlete will make a sudden change of direction by planting and cutting on a fixed foot causing the ACL to rupture. In approximately half the cases of ACL injuries, athletes report the ominious “popping” sound, signaling a ruptured knee ligament.


Studies indicate women are at higher risk for an ACL injury than men in sports involving jumping and change of direction, such as basketball, soccer and volleyball. The gender difference has been, and continues to be, studied with focus on hormonal and structural differences. Researchers are looking at the angle created between the hips and knees, known as the “Q angle,” the size of the notch within the knee where the ACL is located, and muscular strength and reaction time. Another focus area is on the effectiveness of teaching proper jumping and landing mechanics for the reduction of ACL injuries as poor technique often leads to this devastating injury.

Structured athletic enhancement programs, such as Sanford POWER, have proven to be effective for reducing the incidence of ACL injuries. The program is well versed in the instruction and administration of these important exercises to help reduce injury risk.

When an ACL injury occurs, the athlete is often unable to resume activity. There may be swelling around the knee and the athlete may or may not be able to bear weight. Initial treatment of the injury includes applying ice to reduce swelling and provide pain relief, and wrapping, bracing, and/or utilizing crutches to protect the injury. Medical attention will need to be sought from a medical provider, in this case an orthopedic surgeon.

Examination of the knee includes manual tests to determine the extent of the injury to the ACL and to other knee structures. The tests stress the injured structure and provide an initial impression. An MRI, or magnetic resonance imaging, is often sought to provide a detailed picture of the ligaments, cartilage and other soft tissues around the knee. This can confirm the ACL injury and also identify other associated structures that may have been damaged.

Surgery is the most common treatment for this injury, as continued athletic activity with a torn ACL increases the risk for other knee injuries, including damage to the cartilage. There are several techniques that can be performed to reconstruct the ACL. The surgeon decides which method to use based on what would be best for the individual patient.

Following surgery, therapy must begin to restore the knee’s normal range of motion and strength. The rehabilitation is lengthy and, quite often, more challenging than the surgery – even for elite athletes. The process is goal driven while keeping the healing process of the newly reconstructed ACL as the highest priority. Return to play often occurs six to 12 months following surgery, and can include the need to temporarily wear a protective brace.