Anterior Cruciate Ligament Tear

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A tear of the anterior cruciate ligament (ACL) is one of the most well-known and impactful injuries of the knee. It mainly concerns athletes, but also people of every age with an active lifestyle. Despite its frequency, it remains an injury that, if not treated correctly and in time, can radically change the life and activities of the patient, leading even to the early development of arthritis.

Knee pain after a rotational injury is usually the first symptom that leads patients to the practice. It is important not to ignore such an episode, as the anterior cruciate ligament does not heal on its own, and timely diagnosis significantly determines the therapeutic outcome.

As an Orthopaedic Surgeon specialised in arthroscopic knee surgery, my aim through this analytical guide is to explain to you with clarity what exactly happens in an ACL tear, how you will recognise it, what the modern therapeutic options are, and how specialised rehabilitation can return you fully to your favourite activities, with safety and durability over time.

At my practice, I treat daily patients who have suffered an anterior cruciate ligament tear, from high-level professional athletes to amateur athletes who were injured in a basketball game with friends or during a skiing holiday. My experience with thousands of cases of this injury has shown that, with proper diagnosis, personalised surgical technique, and professional rehabilitation, the overwhelming majority of patients return to their previous level of activity. This guide aims to give you all the necessary information so that you can make the right decisions and understand the treatment process from beginning to end.

Ο μόνος Ορθοπαιδικός στην Ελλάδα στην χειρουργική ώμου και άνω άκρου με προϋπηρεσία μόνιμης διευθυντικής θέσης (substantive Consultant ) για 10 συναπτά έτη στην Μεγάλη Βρετανία

What Is the Anterior Cruciate Ligament and what is its Role

The anterior cruciate ligament is a strong fibrous structure located inside the knee joint, connecting the femur to the tibia. It is called “cruciate” because it crosses with the posterior cruciate ligament, forming an X. Despite its small size (approximately 3 centimetres in length and 1 centimetre in thickness), its role is critical for the normal function of the joint.

The Functions of the Anterior Cruciate Ligament

The anterior cruciate ligament is the main stabiliser of the knee and performs the following functions:

It is the basic stabiliser against the forward displacement of the tibia.
It controls the rotational movements of the knee, particularly the internal rotation of the tibia.
It provides proprioceptive information to the brain about the position of the joint.
It contributes to the general stability of the joint in rotations and jumps.

When this ligament suffers a tear, the knee loses its central stability, resulting in the patient experiencing a feeling of instability, particularly during rotational movements, changes of direction, or descending stairs. This chronic instability, if untreated, leads progressively to secondary damage of the menisci and the articular cartilage.

How an Anterior Cruciate Ligament Tear Occurs

An ACL tear occurs in the overwhelming majority of cases without direct contact with another athlete. It is the so-called “non-contact” mechanism, which represents approximately 70% of tears. The mechanism is usually rotational: the patient has the foot firmly on the ground and performs a sudden change of direction or lands after a jump with insufficient control, and the tibia is in rotation.

The Most Frequent Causes of Injury

Sports with sudden changes of direction (football, basketball, volleyball, handball).
Skiing, particularly when one leg remains in rotation.
Incorrect landing after a jump with a straight knee.
Direct injury to the knee (more rarely).
Falls from height or road traffic accidents.
Martial arts and combat sports.

In the characteristic case, the patient reports that they heard a characteristic “pop” or “cracking” sound at the moment of the injury. Intense pain follows, significant swelling within the following hours (haemarthrosis from bleeding), and an inability to continue the activity. Often, an ACL tear is accompanied by simultaneous injuries to menisci, cartilage, or collateral ligaments.

It is particularly important to note that in 50–70% of cases, an ACL tear is accompanied by a meniscal tear, a fact that affects the surgical plan and the recovery time.

Symptoms of an Anterior Cruciate Ligament Tear

The clinical picture of an ACL tear is usually characteristic and recognisable by a specialised Orthopaedic Surgeon. The main symptoms include:

Characteristic “pop” at the moment of injury: The majority of patients (>70%) report that they heard or felt something “pop” in the knee.
Immediate and intense swelling: The knee swells within the first 2–6 hours after the injury, due to intra-articular bleeding (haemarthrosis).
Intense pain: The pain is usually severe during the first days and subsides progressively within 2–3 weeks.
Feeling of instability: It is the most characteristic symptom. The patient feels that the knee “gives way”, that they cannot trust their leg, or that it “escapes” during rotational movements.
Restricted range of motion: Difficulty with full flexion or extension of the knee, particularly during the first days.
Inability to return to sporting activities: Particularly in sports with rotations and jumps, the patient does not feel confident.
Muscle atrophy: In chronic cases, progressive atrophy of the quadriceps muscle appears.

Diagnosis: How We Confirm the Tear

The diagnosis of an ACL tear is based on three pillars: detailed medical history, careful clinical examination, and targeted imaging assessment. The correct and timely diagnosis is critical, as it determines the treatment plan and the success of the rehabilitation.

Clinical Examination

In the clinical examination, I use specific tests of high diagnostic value. These allow me, in experienced hands, to make the diagnosis with accuracy approaching 95%, even before the imaging examination:

Lachman test: The most sensitive and reliable clinical test for an ACL tear.
Pivot shift test: Evaluates the rotational instability of the knee.
Anterior drawer test: A classic test for the evaluation of stability.

Imaging Assessment

After the clinical examination, the following are requested:

Digital X-rays: To rule out concomitant bony injuries or fractures.
Magnetic Resonance Imaging (MRI): This is the examination of choice. The MRI confirms the tear, evaluates its extent (partial or complete), and detects concomitant injuries (meniscal tears, cartilage lesions, bone bruises), which are particularly frequent in cases of ACL tear.

Modern Therapeutic Management

The treatment of an anterior cruciate ligament tear is personalised according to age, level of activity, expectations, and concomitant injuries. Not all ACL tears need surgical treatment, but the majority of active individuals benefit significantly from arthroscopic reconstruction.

Conservative Treatment

It is appropriate for older patients with low demands, who do not participate in sports with rotational movements. It includes a targeted physiotherapy programme with emphasis on strengthening the quadriceps and hamstrings, work on balance and proprioception, modification of activities, and use of a special knee brace in certain cases.

Arthroscopic ACL Reconstruction

It is the gold-standard therapeutic option for young and active patients. It is a minimally invasive operation, which is performed through two small incisions of 5–7 millimetres. The old ligament is not “sutured” (as this fails in the overwhelming majority of cases), but a new ligament is constructed (“neo-ligament”).

Knee arthroscopy is the general platform for all modern minimally invasive surgical techniques applied to the knee, including ACL reconstruction. With this method, the ideal combination of excellent surgical outcome and rapid postoperative recovery is achieved.

Choice of Graft

The choice of the appropriate graft is personalised for each patient, depending on age, sport, and other factors:

Hamstring tendons: The most common choice worldwide. It provides excellent results with minimal discomfort at the harvest site and an excellent aesthetic result.
Patellar tendon (BTB – Bone-Tendon-Bone): An excellent choice for professional athletes, with high rates of return to high competitive levels.
Quadriceps tendon: An excellent modern option, ideal for revisions or for patients who wish to avoid harvesting from the hamstrings.

The graft is placed with millimetric accuracy at the anatomical positions of the knee (anatomical placement), ensuring that the new structure will function as normally as possible. The modern technique provides for the use of special fixation systems (suspensory fixation, interference screws) that guarantee stable integration.

The accuracy of the anatomical placement of the graft is one of the most important factors in the success of the operation. In the past, the techniques placed the graft in non-anatomical positions, with the result of affecting the affected normal biomechanics of the knee and causing premature wear of the new ligament. Today, using specialised instruments and the deep knowledge of anatomy, we place the graft exactly at the positions of the normal anterior cruciate ligament. This ensures not only the stability of the knee in all movements, but also the preservation of the normal rotational function, which is critical for rotational sports. Furthermore, the correct tension of the graft during placement is extremely important: an overly tensioned graft can cause stiffness in the knee, while a loose graft does not provide the necessary stability.

Cost and Price of the ACL Reconstruction Operation

One of the most frequent questions of patients concerns the cost and price of arthroscopic ACL reconstruction. It is important to understand that this operation is a specialised medical procedure, of great surgical difficulty, which requires modern equipment, high-quality materials, and experience.

The final cost and the price of the operation are shaped by many factors:

The clinic or hospital where the operation will be performed.
The days of hospitalisation (usually 1–2 days).
The type and quality of the materials (fixation systems, instruments).
The choice of graft (autograft or allograft).
The presence of concomitant injuries that require simultaneous treatment (e.g., meniscal tear).
The involvement of your insurance provider (EOPYY or private insurance).
The cost of anaesthesia and the surgical environment.

Postoperative Rehabilitation: The Key to Success

The success of an arthroscopic ACL reconstruction does not depend only on excellent surgical technique, but also on a strictly personalised rehabilitation programme. Cooperation with a specialised physiotherapist is essential, and the process is divided into distinct phases.

Because every case is unique, the accurate estimate of the cost can only be made after a complete appointment, in which I will study your imaging findings, evaluate the extent of the damage, and together we will design the optimal treatment plan. Transparency and full information are basic principles of my medical practice.

Phase 1 (0–4 weeks): Pain Control and Initial Rehabilitation

Control of pain and swelling, recovery of full extension, and activation of the quadriceps with isometric exercises. Walking is allowed from the first day with the use of crutches.

Phase 2 (4–12 weeks): Strengthening and Range of Motion

Gradual increase of range of motion, strengthening of muscle groups, work on a stationary bike, balance, and proprioception exercises. Gradual discontinuation of crutches.

Phase 3 (3–6 months): Functional Strengthening

Beginning of running in a straight line, high-intensity strengthening, functional exercises, and beginning of plyometric exercises.

Phase 4 (6–9 months): Sport-Specific Training

Gradual return to sporting activities, exercises with rotations and jumps, sport-specific training (cutting drills, agility).

Phase 5 (9–12 months): Return to Competitive Sports

Full return to competitive sports, after functional tests (Return-to-Sport tests) that confirm the readiness of the patient. Early return dramatically increases the risk of a new tear.

Experience and Specialisation Matter

Having served as a permanent Consultant in Orthopaedics in Great Britain (NHS) for 10 years, and with a clinical record that exceeds 9,000 arthroscopic and open operations, the reconstruction of the anterior cruciate ligament is one of the most frequently performed operations in my surgical repertoire.

I have undertaken extensive further training (fellowships) in arthroscopic knee surgery at internationally top centres abroad, applying the most modern techniques of anatomical reconstruction. This experience allows me to choose for each patient the most appropriate technique and the ideal graft, fully personalising the treatment. More information can be found at drpolyzois.gr.

You can be informed in detail about my curriculum vitae and my specialisations, my international further training, and my long-term experience in thousands of cases of great surgical difficulty.

Return Safely to Your Favourite Activities

An anterior cruciate ligament tear does not mean the end of sporting or active life. With modern techniques, a specialised team, and proper rehabilitation, the return to the activities you love is absolutely achievable. Orthopaedic science has evolved significantly and today offers reliable solutions for every patient.

Contact our practice today through the website drpolyzois.gr to schedule a diagnostic appointment. We will analyse your case in detail, I will answer every question, and together we will design the optimal treatment strategy, personalised to your own goals and your life.

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Συχνές ερωτήσεις

Can I live without an anterior cruciate ligament?

Yes, provided you accept significant restrictions in your life. Older individuals or those with low sporting demands can live without reconstruction, with appropriate strengthening. However, chronic instability leads to secondary meniscal tears, cartilage damage, and early knee arthritis, an irreversible condition.

How soon can I have surgery after the injury?

We usually wait 2–4 weeks, so that swelling decreases and a good range of motion is recovered. Surgical intervention on a knee with intense swelling and stiffness increases the risk of complications, such as postoperative arthrofibrosis (stiffness).

When can I return to sport?

The safe return to rotational and contact sports is generally placed at 9–12 months after the operation. The exact moment depends on the progress of rehabilitation and the results of specific functional tests. Early return dramatically increases the risk of a new tear.

What is the success rate of the operation?

With a modern anatomical technique and proper rehabilitation, success rates exceed 90–95%. Most patients fully return to the sporting activities they had before the injury.

Is there a risk of re-tear after the operation?

The risk exists, but it is small (approximately 3–7%). It is greater in young patients who return to high-level sports. Strict adherence to the rehabilitation programme and the special tests before return to sport drastically reduces this risk.

Can I play sports again at the same level?

In the overwhelming majority of cases, yes. Patients, even professional athletes, return to their previous level. The correct technique, the specialised rehabilitation, and the full compliance of the patient are the key factors.

What will happen if I do not have surgery?

In an active individual who participates in sporting activities with rotations and jumps, the non-surgical treatment usually leads to recurrent episodes of instability. Each such episode can cause new damage to the menisci and the articular cartilage, leading progressively to early osteoarthritis. In elderly patients with low physical activity, the non-surgical approach may be appropriate, provided that a prudent modification of activities is made.

Is the postoperative period painful?

The modern way of pain management allows for a comfortable postoperative period. We use a combination of regional anaesthesia, personalised pharmaceutical therapy, and the application of ice. Most patients report controlled pain during the first 2–3 days, which subsides gradually. The minimally invasive technique of arthroscopy contributes decisively to the reduction of postoperative pain compared to older open techniques.

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