What is an (ACL) anterior cruciate ligament injury?

The cruciate ligaments are found in the middle of your knee joint, forming an “X” configuration as they cross each other to connect the thigh bone (femur) and the shin bone (tibia). The anterior cruciate ligament (ACL) prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.

The mechanisms of an ACL injury include quick changes in direction (pivoting/cutting), stopping suddenly, landing awkwardly from a jump, and direct collisions. Female athletes are more prone to ACL injuries than males due to a number of physiological and biomechanical factors.

ACL injuries are usually complete or near-complete ligament tears, with partial injuries being rare. Over half of ACL injuries are associated with additional damage to the knee such as cartilage damage, meniscal tears and injuries to other ligaments.

What are the symptoms of an (ACL) injury?

At the time of the ACL injury, your knee may have given way and many people feel or hear a “popping” sensation. The deep pain and rapid onset of swelling make it very difficult to carry on with the activity or bear weight on the leg. Once the pain and swelling have resolved your knee can feel unstable and may continue to give way. Returning to pivoting/cutting activities is often impossible. Each giving way episode can cause further damage to your knee.

How is an ACL injury diagnosed?

The symptoms and a careful examination will usually suggest the diagnosis. An x-ray can be useful, but an MRI scan is the investigation of choice.

How is an ACL injury treated?

The treatment of ACL injuries is individualised to each patient based on activity levels and demands, age and associated knee injuries. Initial treatment is aimed at managing the pain and swelling through rest, analgesia/anti-inflammatory medication and ice. Crutches may be used to help mobility and a knee brace can help prevent further instability. As the pain and swelling subside, specific rehabilitation is started to restore motion, function and strength to your knee and leg.

Although a torn ACL will not heal, not everyone requires surgery. Physiotherapy and rehabilitation, however, plays a crucial role for everyone.  Less active, usually older, individuals with less demanding activity levels can achieve overall knee stability with a focussed rehabilitation programme. People with higher activity levels and sporting demands usually require surgical intervention to reconstruct the torn ACL.

ACL reconstruction involves replacing your torn ligament with a tissue graft. There are several potential options including hamstring tendons at the back of your knee, part of the patella tendon that runs between the kneecap and tibia, and quadriceps tendon that runs up from the kneecap into the thigh. Donated graft (allograft) may also be used. The advantages and disadvantages of each option will be discussed by the surgeon to choose the best graft option for each individual.

It takes time for the graft to incorporate and function efficiently. Return to sport can take at least 6-months; often longer. Consequently, physiotherapy and rehabilitation are pivotal to the success of the surgery. Although at times you may feel frustrated, commitment to therapy is the most important factor in getting back to the activities you enjoy.

If you or someone you know has suffered an injury or is experiencing pain across their lower limbs or difficulty with mobility and would like a consultant-led review, please contact us. Grosvenor Orthopaedics have extensive experience in the treatment of knee-related injuries with excellent patient outcomes.


Grosvenor Orthopaedics have extensive experience in the treatment of knee-related injuries with excellent patient outcomes.


If you would like to learn about other knee conditions click the button below to find out more


If you would like to learn about other knee treatments click the button below to find out more


The Knee Service at Grosvenor Orthopaedic Partners is led by Mr Luke Jones and Mr Chethan Jayadev, both Oxford PhD educated knee surgeons with London Teaching Hospital NHS consultant posts. They provide a comprehensive range of knee procedures as part of a multidisciplinary team of healthcare professionals including highly specialised physiotherapists, all committed to returning you to optimal function.

Our team are well placed to manage and treat a diverse range of knee problems utilising cutting edge diagnostic technology and treatment approaches, both surgical and conservative. Below is an overview of some of the knee conditions we treat but for a more thorough understanding please contact our team here


Consultant Orthopaedic Knee Surgeon

DPhil(Oxon), FRCS(Tr&Orth), MB BS, BSc(hons)
Luke is a Consultant Knee Surgeon practising at Chelsea and Westminster Hospital NHS Foundation Trust, and the Lister Hospital, Chelsea. He runs a high volume bespoke specialist knee practice that deals with all aspects of knee surgery from minor sports injuries to complex joint reconstructions.


Consultant Orthopaedic Knee Surgeon

MA(Oxon) BMBCh DPhil(PhD) FRCS(Tr&Orth)
Chethan is a Consultant Knee Surgeon practising at the world-renowned Royal National Orthopaedic Hospital Stanmore, Spire Bushey Hospital and King Edward VII’s Hospital. His practice encompasses all aspects of knee surgery, from sports injuries and knee preservation to complex and redo joint replacements. He has a reputation as a thorough, meticulous surgeon offering patients a bespoke and personalised service. He is dedicated to providing the most up-to-date and evidence-based care. Chethan is a strong advocate of patient choice and always puts patients first


Consultant Orthopaedic Knee Surgeon

MBBS MSc FRCS (Tr & Orth)
Mark is a Consultant Orthopaedic Surgeon with a passion for sports related injuries. He strives to not only provide excellent surgical treatments but also rounded, bespoke care that allows his patients to get back to the activities they love. This is evident in his specialist training which includes a Master’s degree in Sports Medicine from University College London to help him when treating all levels of athletes. Alongside surgical treatments, Mr. Webb offers non-operative (conservative) options including using orthobiologics, such as PRP and stem cells, to treat the symptoms of early arthritis, as well as tendon injuries. Treatment plans are tailored to the patient’s requirements and expectations using the best evidence available

What some of our patients say

Mrs MA

Thank you for taking care of me. You went above and beyond and I am so touched and grateful. My knee feels fine now