An anterior cruciate ligament (ACL) tear is one of the most common serious knee injuries in athletes. At Orthopaedic Sports Specialists (OSS), our fellowship-trained orthopaedic sports medicine surgeons provide comprehensive evaluation and treatment of ACL injuries for recreational athletes, high school and collegiate athletes, and active adults throughout Connecticut and the surrounding region.

Alex G. Dukas, MD and Christian A. Merrill, MD, MBA specialize in sports-related knee injuries, including primary and revision ACL reconstruction, meniscus repair, cartilage injuries, patellar instability, and complex ligament injuries of the knee.

Our goal is not simply to reconstruct the ACL. Treatment is individualized to restore knee stability, protect the meniscus and articular cartilage, and help each patient safely return to the activities and sports that matter to them.

What Is the ACL?

The anterior cruciate ligament, or ACL, is one of the major stabilizing ligaments of the knee. It connects the femur (thigh bone) to the tibia (shin bone) and helps control forward movement and rotation of the knee.

The ACL is particularly important during activities involving cutting, pivoting, jumping, sudden changes in direction, and deceleration. For this reason, ACL injuries are common in sports such as soccer, football, basketball, lacrosse, skiing, and gymnastics.

What Causes an ACL Tear?

Many ACL tears occur without direct contact with another athlete. A sudden change in direction, awkward landing, pivot, or rapid deceleration can place enough stress on the ligament to cause it to tear.

ACL injuries can also occur through direct contact, particularly when an athlete is struck around the knee while the foot is planted.

Some patients describe hearing or feeling a “pop” when the injury occurs.

Symptoms of an ACL Tear

Common symptoms include:

• A popping sensation at the time of injury

• Rapid knee swelling

• Pain and difficulty continuing activity

• Loss of knee motion

• A feeling that the knee is unstable or may “give way”

• Difficulty with cutting, pivoting, or changing direction

Not every ACL tear feels the same. Some patients are able to walk shortly after the injury, while others develop significant swelling and difficulty bearing weight.

How Is an ACL Tear Diagnosed?

Diagnosis begins with a detailed history and physical examination. Specific examination techniques allow an orthopaedic sports medicine specialist to assess the stability of the ACL and other important structures around the knee.

X-rays may be obtained to evaluate the bones and identify associated injuries. MRI is commonly used to confirm the ACL tear and evaluate the menisci, cartilage, other ligaments, and surrounding structures.

Importantly, treatment decisions should not be based on the MRI alone. The patient's examination, age, activity level, athletic goals, associated injuries, and symptoms all contribute to determining the best treatment plan.

Do All ACL Tears Require Surgery?

No.

Some individuals with ACL tears can be successfully treated without surgery, particularly those who do not participate in cutting or pivoting activities and whose knees remain functionally stable.

Nonoperative treatment typically includes physical therapy focused on restoring motion, strength, balance, and neuromuscular control.

ACL reconstruction is more commonly considered for athletes who wish to return to cutting and pivoting sports, patients experiencing recurrent instability, and individuals whose activity demands require a stable ACL.

Associated injuries may also influence the decision. For example, an unstable knee with a repairable meniscus tear may benefit from surgical stabilization to protect the meniscus and overall health of the knee.

Who Should Consider ACL Reconstruction?

ACL reconstruction may be appropriate for patients who:

• Want to return to cutting, pivoting, or high-demand sports

• Experience recurrent knee instability

• Have physically demanding occupational requirements

• Have associated meniscus or other ligament injuries

• Are unable to return to desired activities despite appropriate rehabilitation

Age alone does not determine whether someone is a candidate for ACL reconstruction. Treatment is individualized according to the patient's goals, knee stability, associated injuries, activity level, and overall health.

ACL Reconstruction Surgery

ACL reconstruction replaces the torn ligament with a tendon graft. The procedure is typically performed arthroscopically through small incisions around the knee.

During surgery, the knee is carefully evaluated for associated injuries. Meniscus tears and cartilage injuries can often be addressed during the same procedure when appropriate.

The graft is positioned anatomically to reproduce the function of the native ACL and secured to the femur and tibia while it heals and incorporates into the knee.

Modern ACL surgery is highly individualized. Graft selection, tunnel positioning, fixation technique, treatment of associated injuries, and postoperative rehabilitation all play important roles in the outcome.

Choosing an ACL Graft

There is no single graft that is best for every patient.

Common ACL graft options include:

Patellar Tendon Autograft

A portion of the patient's patellar tendon is used along with a small bone plug from the patella and tibia. Patellar tendon grafts have a long history of successful use, particularly in young and high-demand athletes.

Quadriceps Tendon Autograft

A portion of the quadriceps tendon above the kneecap is used to reconstruct the ACL. Quadriceps tendon grafts provide a strong, versatile option and are increasingly used in both primary and revision ACL reconstruction.

Hamstring Tendon Autograft

One or more of the patient's hamstring tendons can be used to create the ACL graft. Hamstring grafts remain appropriate in selected patients.

Allograft

Allograft tissue comes from a screened donor rather than the patient's own tendon. Allografts can be useful in selected situations, although graft choice requires particular consideration in young and highly active athletes.

Drs. Dukas and Merrill discuss the advantages and disadvantages of each option with patients before surgery. Age, sport, position, activity level, anatomy, previous surgery, and personal priorities are considered when selecting a graft.

Meniscus, Cartilage and Other Ligament Injuries

ACL tears frequently occur with additional knee injuries.

The meniscus is particularly important because it distributes load across the knee and helps protect the articular cartilage. When possible, preserving and repairing injured meniscus tissue is generally preferred to removing it.

ACL injuries may also occur with cartilage damage or injuries to the medial collateral ligament (MCL), lateral collateral ligament (LCL), posterior cruciate ligament (PCL), or posterolateral corner.

Identifying and appropriately treating these associated injuries is an important part of restoring knee stability and protecting long-term joint health.

Revision ACL Reconstruction

Unfortunately, an ACL reconstruction can occasionally fail because of a new injury, graft failure, technical factors, unrecognized associated instability, or other causes.

Revision ACL reconstruction is often more complex than primary surgery.

Evaluation may include specialized X-rays, MRI, and occasionally CT imaging to assess previous tunnels, fixation, alignment, meniscus status, cartilage, and other stabilizing structures of the knee.

Some revision ACL procedures can be completed in a single operation. More complex cases may require staged treatment.

At OSS, revision treatment is individualized based on the cause of failure and the patient's anatomy, activity level, previous procedures, and future athletic goals.

Recovery After ACL Reconstruction

Recovery after ACL reconstruction is a progression rather than a single timeline.

Early rehabilitation focuses on:

• Controlling swelling

• Restoring full knee extension

• Gradually restoring flexion

• Normalizing walking

• Restoring quadriceps activation and strength

Patients then progress through strengthening, balance, neuromuscular training, running, jumping, agility, and sport-specific activities.

The rehabilitation program may be modified when ACL reconstruction is combined with meniscus repair, cartilage surgery, or treatment of another ligament.

Physical Therapy After ACL Reconstruction

Physical therapy is one of the most important components of successful ACL treatment.

OSS offers physical therapy within our Glastonbury office, allowing close communication between the surgeon, physician assistants, and rehabilitation team throughout recovery.

Rehabilitation progresses according to both healing and functional milestones rather than simply advancing because a certain number of weeks have passed.

The ultimate objective is to restore motion, strength, power, neuromuscular control, confidence, and sport-specific function.

When Can I Return to Sports?

Return to sport after ACL reconstruction should be individualized.

Time from surgery is important, but time alone does not determine whether an athlete is ready to return.

Before clearance for unrestricted sports, we consider factors such as:

• Knee stability

• Full or near-full range of motion

• Absence of significant pain or swelling

• Quadriceps and hamstring strength

• Functional testing

• Jumping and landing mechanics

• Sport-specific performance

• Psychological readiness

• The athlete's age and sport

• Associated injuries and procedures

For young athletes in particular, returning too early can increase the risk of another ACL injury.

Our goal is not simply to get an athlete back onto the field as quickly as possible. Our goal is to help the athlete return safely and successfully while reducing the risk of reinjury whenever possible.

Why Choose Orthopaedic Sports Specialists for ACL Treatment?

ACL treatment is a major focus of our sports medicine practice.

Alex G. Dukas, MD and Christian A. Merrill, MD, MBA are fellowship-trained orthopaedic sports medicine surgeons with extensive experience treating athletic knee injuries, including primary and revision ACL reconstruction, meniscus repair, cartilage procedures, patellar instability, and complex knee injuries.

Our physicians have provided sports medicine care to athletes at the professional, collegiate, scholastic, and recreational levels.

OSS physicians serve or have served athletes associated with organizations including UConn Athletics, the Hartford Yard Goats, Hartford Athletic, and Loomis Chaffee School.

The same principles used when caring for competitive athletes guide the treatment of every patient: accurate diagnosis, individualized treatment, preservation of healthy tissue whenever possible, evidence-based rehabilitation, and a thoughtful approach to returning to activity.

Our Glastonbury office also offers on-site imaging and physical therapy, allowing patients to receive coordinated orthopaedic and rehabilitation care in one location.

Frequently Asked Questions About ACL Tears

Can an ACL tear heal without surgery?

Some patients can function successfully without ACL reconstruction, particularly if their knee remains stable and they do not participate in activities requiring frequent cutting and pivoting. Treatment should be individualized according to symptoms, activity goals, associated injuries, and knee stability.

Can I play sports with a torn ACL?

Some activities may be possible, but returning to cutting and pivoting sports with an ACL-deficient knee can result in recurrent instability. Repeated episodes of the knee giving way may also place the meniscus and cartilage at risk.

How soon after an ACL tear should surgery be performed?

ACL reconstruction usually does not need to be performed immediately. Restoring motion, decreasing swelling, and improving muscle function before surgery can be beneficial. Associated injuries can occasionally change the timing. However waiting an extended period of time can further damage the knee

What is the best graft for ACL reconstruction?

There is no universally best ACL graft. Patellar tendon, quadriceps tendon, hamstring tendon, and allograft tissue each have advantages and disadvantages. The appropriate graft depends on factors including age, sport, activity level, anatomy, previous surgery, and individual priorities.

What happens if I also tear my meniscus?

Meniscus injuries commonly occur with ACL tears. When a meniscus tear is repairable, preserving and repairing the meniscus is often preferred. The treatment plan and rehabilitation may be modified when meniscus repair is performed with ACL reconstruction.

When can I start running?

Running is introduced after appropriate healing and after sufficient motion, strength, control, and tolerance have been restored. Readiness is more important than reaching a predetermined date on the calendar.

When can I return to competitive sports?

Return to sport varies according to the athlete, sport, graft, associated injuries, rehabilitation progress, and functional testing. Athletes should demonstrate appropriate strength, stability, movement quality, functional performance, and readiness before unrestricted return.

Why is return-to-sport testing important?

An athlete may feel normal before strength, power, balance, and movement patterns have fully recovered. Objective testing provides additional information that helps the surgeon and rehabilitation team make a more informed return-to-sport decision.

Can an ACL reconstruction tear again?

Yes. A reconstructed ACL can sustain another injury, and young athletes participating in cutting and pivoting sports also have a risk of ACL injury to the opposite knee. Appropriate rehabilitation, neuromuscular training, functional testing, and thoughtful return-to-sport decisions are therefore important.

What if my previous ACL reconstruction failed?

A failed ACL reconstruction does not necessarily mean an athlete cannot return to sports. Revision ACL reconstruction can be successful, but determining why the original reconstruction failed is important. Revision treatment may require additional imaging and a more individualized surgical strategy.

Schedule an ACL Evaluation

If you have sustained an ACL injury or have persistent knee instability, the sports medicine team at Orthopaedic Sports Specialists can evaluate your injury and discuss both surgical and nonsurgical treatment options.

We treat athletes and active patients throughout Glastonbury, Greater Hartford, Connecticut, and the surrounding New England region.

Orthopaedic Sports Specialists
84 Glastonbury Boulevard, Suite 101
Glastonbury, CT 06033
860-652-8883