• Grade 1 ACL Sprain: The ligament is stretched but not torn. This usually heals with rest, ice, and anti-inflammatory medications.
• Grade 2 Partial ACL Tear: Some of the ligament is torn. It might heal with physical therapy and bracing, but surgery might be needed if instability continues.
• Grade 3 Complete ACL Tear: The ligament is completely torn. Surgery is usually needed, especially for athletes who want to return to their sport.

Doctors use a detailed history, physical exam, x-rays, and MRI scans to diagnose ACL injuries. An MRI helps check for other possible knee injuries since ACL tears often come with additional damage. Special physical tests, like the Lachman, Anterior Drawer, and Pivot Shift Tests, help confirm the injury.

Some ACL tears can heal themselves depending on the severity of the tear. However, the vast majority of ACL tears, particularly complete ruptures cannot. The ACL is under a great deal of motion and mechanical stress and due to its location, blood supply, and quick ability to form scar, even if it heals it may not be fully functional causing a person to still feel unstable. The bottom line is a torn ACL that does not have rotational stability can avoid surgery, but if a patient has continued rotational instability and pivoting even if their MRI shows a healed ligament there ACL may not be functioning appropriately.

It’s often best to start with physical therapy to reduce pain and swelling, and regain full range of motion, and then have surgery. Waiting until your knee is less swollen and has better movement usually leads to better results. The exact timing for surgery depends on your individual situation.

ACL surgery is done using a small camera and tools through tiny cuts in your knee. The torn ACL is replaced with a tendon graft, which can come from your own body or a donor. Surgery can also fix any other damage to the knee, like a torn meniscus.

ACL tears do not always require surgery. Patients who participate in cutting and pivoting sports such as basketball, football soccer, tennis and martial arts would benefit from an ACL repair (fixing your natural ACL tissue) or ACL reconstruction (creating a new ACL for you).

If you have torn your ACL and your knee is unstable rotationally, your knee is at greater risk for further damage if you continue to play cutting and pivoting sports. An intact ACL decreases the chances of rotational instability and thus can protect the meniscus and cartilage from injuries. An ACL is a much smaller problem then meniscus and cartilage damage which in some cases can be irreparable. Thus, if you decide not to fix your ACL and you are not playing any cutting or pivoting sports your risk is much lower than if you decide to not fix your ACL but attempt to return to playing cutting and pivoting sports.