You Tore Your ACL, Now What?

Posted on: April 1st, 2025 by Our Team

Tearing your Anterior Cruciate Ligament (ACL) can feel devastating, but the right approach from the start can make a huge difference in your recovery. Whether you’re an athlete aiming to return to competition or simply seeking to regain full function, the steps you take immediately after your injury will lay the foundation for a successful outcome.

Step 1: Regain Your Range of Motion

After being diagnosed with an ACL tear, your first priority should be restoring your range of motion, especially full extension (straightening your knee) and full flexion (bending it completely). We don’t want to operate on someone who hasn’t regained full range of motion because your preoperative motion predicts your postoperative outcome. If you go into surgery with stiffness, you’ll come out with stiffness, which can severely impact your long-term recovery.

To restore motion, focus on:

• Extension: Work on getting your knee completely straight by propping your heel on a stack of towels or pillows while keeping nothing behind your knee.
• Flexion: Perform gentle bending exercises, like heel slides, to regain the ability to fully bend your knee.

Step 2: Control Swelling with Ice and Elevation

Swelling can limit motion, so managing inflammation is critical.

• Ice: Apply ice for 20-minute intervals several times a day to reduce pain and swelling.
• Elevation: Elevate your knee above heart level, but avoid placing a pillow directly under your knee, as this can hinder extension. Instead, support your heel, allowing gravity to help straighten your knee.

Step 3: Use Anti-Inflammatories and Compression

Anti-inflammatory medications (such as ibuprofen or naproxen) can help manage pain and swelling in the early stages. However, they should be used under a physician’s guidance to avoid potential side effects.

Compression is also key. A well-fitted compression sleeve or wrap can help limit swelling and provide support while you work on regaining mobility.

Step 4: Get a Surgical Consultation

Once you’ve restored your range of motion and controlled swelling, it’s time to consult with an orthopedic surgeon. While your primary care doctor can confirm the injury and manage initial pain, a sports medicine fellowship-trained orthopedic surgeon will evaluate your injury, discuss treatment options, and determine if surgery is necessary.

Step 5: Research Graft Options

If ACL reconstruction is required, and you are not a candidate for an ACL repair (fixing the torn ACL), the next decision is choosing the graft. The graft is the tissue used to replace your torn ACL, and there are several options:

Autografts (Your Own Tissue)

• Patellar Tendon: Excellent for higher-level athletes with great fixation but may cause pain in the front of the knee.
• Hamstring Tendon: Less painful at the donor site but may cause some hamstring weakness and, in some studies, has shown inferior results compared to other options.
• Quadriceps Tendon: Gaining popularity; offers a good balance of strength and lower donor site pain.

Allografts (Cadaver Tissue)

• Can come from the patellar tendon, hamstring, Achilles tendon, or other sources.
• Avoid donor site pain but may have a slightly higher failure rate in younger athletes.

The right graft depends on factors like age, activity level, sport, and personal preference. We’ll discuss this topic in more detail in an upcoming blog.

Tearing your ACL is a significant injury, but by taking the right steps early—restoring range of motion, managing swelling, seeking expert consultation, and researching your options—you’ll set yourself up for the best possible recovery. Stay tuned for more on graft choices, rehabilitation timelines, and return-to-play strategies in future posts.