ACL injuries: What you need to know

Written by: Dr Philip Batty
Edited by: Kate Forristal

In his latest online article, Dr Philip Batty gives us his insights into ACL injuries. He talks about how they occur, the signs and symptoms, the difference between ACL tear and ACL sprain, if surgery is always needed, how long it takes to heal and could patients retear their ACL.

How do ACL injuries occur?

Primarily, these incidents typically happen when an individual is loading their knee and loses control. This can occur due to a forceful impact or being struck, causing the knee to turn inward and twist into what we refer to as a knee valgus position. These incidents are most commonly associated with situations involving this particular movement, as it is during such moments that the ACL is particularly susceptible to injury.


What are the signs and symptoms of ACL injuries?

Often, individuals may mention experiencing discomfort, although it's not a consistent symptom. They might sense an unsteady moment and feel as if something has given way. Some may recall hearing a popping sound. Swelling is a potential indicator, and it could manifest promptly or gradually over a few hours.


Pain may accompany the swelling, but in certain instances, the occurrence might not be immediately apparent to individuals, and they may not be fully conscious that it has taken place.


What is the difference between an ACL tear and an ACL sprain?

Based on that, I would infer that an ACL tear involves a complete rupture, rendering the ACL non-functional. However, there are also less severe sprains that can occur.


These minor sprains typically develop gradually and may have a more degenerative nature. Individuals might notice a slight loss of control or experience stability issues with the knee.


Is surgery always needed to treat ACL injuries?

Surgery isn't always necessary for treating ACL injuries, as many individuals lead active lives without undergoing surgical intervention. There's even a case report of a Premier League footballer who continued playing without an ACL.


While some people manage well without an ACL, others may face challenges. Regardless, whether dealing with an ACL-deficient knee or undergoing ACL reconstruction surgery, the crucial focus is on restoring and enhancing strength, particularly in the leg muscles. Muscles play a primary role in providing stability to the knee. Issues arise when muscles are weak or imbalanced. The goal is to minimise the reliance on ligaments by ensuring that the muscles influencing the knee are robust.



How long do ACL injuries usually take to heal?

ACL injuries typically do not undergo spontaneous healing. The restoration of knee function varies. Opting for a non-surgical approach allows individuals to resume most activities within two to three months, as seen in the case of the previously mentioned Premier League footballer. However, if surgery is chosen, the recovery period is more substantial. Achieving full functionality usually takes about nine to twelve months, with ongoing improvement thereafter. By the 12-month mark, one can generally expect a recovery of 95% or more. Premier League footballers who undergo surgery often return around the nine-month mark, benefiting from intensive collaboration with expert medical teams.


Could patients retear their treated ACLs?

We are currently examining data related to this issue, and findings vary among surgeons, contingent on their reports and the age of the patients. Retear rates can be around 30%, especially in the younger age group. Therefore, there is a pressing need to intensify efforts in preventing the recurrence of ACL injuries.


Dr Philip Batty is an esteemed consultant in sport and exercise medicine with over 35 years of experience. You can schedule an appointment with Dr Batty on his Top Doctors profile.

By Dr Philip Batty
Sports medicine

Dr Philip Batty is a highly distinguished consultant in sports and exercise medicine based in London. With more than 30 years of experience, he is internationally recognised for his role and expertise in elite sports medicine, using exercise as a rehabilitation tool for all kinds of sports injuries.

Included in his clinical practice is the treatment and management of musculoskeletal conditions, including back pain, ACL injuries, ankle sprains, hip pain, and shoulder pain. Dr Batty originally qualified from the University of Liverpool in 1987. Following initial physician appointments in Lancaster, he became deputy club doctor at Manchester United Football Club in 1996, commencing what would be an illustrious career in sports and exercise medicine.

In 1999, Dr Batty joined Blackburn Rovers Football Club as head of sports medicine and combined this role with sports physician and GP services at the English Institute of Sport and at Sedbergh School, looking after both professional and recreational athletes of all ages. Dr Batty was later named head of sports medicine at Manchester City Football Club and worked there from 2011 to 2012, the first year the club won the Premier League.

This post was followed by Dr Batty's appointment as team doctor for the Rugby Football Union, the Middlesex County Cricket Club and consultant for the English National Ballet. Within private practice and the NHS, Dr Batty was the medical director of the Isokinetic FiFA Centre of Medical Excellence from 2013 to 2020. He was previously med alert doctor at the North West Ambulance Service and an honorary consultant in orthopaedics at the Royal National Orthopaedic Hospital, Wrightington.

Standard-setting as former vice president of the Faculty of Sport and Exercise Medicine, Dr Batty is also a prominent figure in the development of sports and exercise medical education in the UK. He was training programme director for the North West Deanery and a senior lecturer at the University of Salford and University College London. Prior to this, Dr Batty served as the president-elect, and educational and clinical lead for the Independent Doctors Federation. Dr Batty’s industry-leading research has shown that tiredness increases the risk of injury during sport, and that alcohol can exacerbate recovery. As a renowned and highly-sought expert in sports medicine, Dr Batty believes in the value of physical activity for the prevention and rehabilitation of conditions, working in partnership with his patients to find out their individual injury treatment strategy.

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