Tears of the anterior cruciate ligament or ACL are quite common with a prevalence between 100,000 to 200,000 every year in the US.

The ACL is one of the four major ligaments located in the knee joint. The ACL provides rotational stability to the knee and prevents the shinbone, also known as tibia, from slipping in front of the thigh bone, which is also known as the femur.

The ACL is vulnerable to several injuries, especially if you are an athlete. Sportsmen associated with sports such as soccer, skiing, basketball, cricket, etc often face ACL injuries. There is a high possibility for ACL tears occurring in players who are into sports that involve a lot of leg planting, pivoting, and cutting. An ACL tear occurs when a partial or complete rupture happens to the ACL. If torn or ruptured, the ACL cannot regrow on its own.

When the ACL tears in a person, they may hear a popping sound as the tear occurs. The person may witness swelling in the knee and in many cases, the knee might even become unstable. Depending upon the severity of the injury, the symptoms may vary from mild to moderate to extreme.

Now, the important question here is, what should a person do if he or she gets an ACL tear?


What to do in case of an ACL tear?

Ideally, any patient with an ACL tear is suggested to undergo a surgical treatment as soon as the ACL tear occurs. Delaying the surgery can worsen the conditions and the ACL tears have the potential to cause meniscal tears later.

In a study mentioned in an article by Peak Performance Physical Therapy, 13 people with ACL injuries who delayed their surgery were studied. The study that all the 13 people who delayed their surgeries and continued working, suffered from a complete tear of the ligament.

The ACL is vital for the proper functioning of the knee. And continuing to work with any form of ACL deficiency may not just make the tear chronic, but also lead to injury of the meniscus and degeneration of the joint. The meniscus is a C-shaped rubbery and tough cartilage that acts as a shock absorber between the thigh bone and the shinbone. When the study was initiated, only half of the people in the group had a meniscal tear during the first MRI. But when the surgery was delayed, the mescal condition worsened till the time of the second MRI.


What happens if ACL surgery is delayed?

Delay in the ACL surgery can increase the risks and complications of a permanent injury.

  1. An ACL injury can lead to other knee ligament injuries.

No matter what the severity is, once an ACL tear occurs, the knee becomes unstable. When a person continues to work with an ACL injury, the mechanical stress and weight on the meniscus and the surfaces covering the knee joint increases. Because you continue to walk and move with an unstable knee, there is a high risk for a meniscus injury or articular injury occurring due to it.

  1. Delaying surgery can lead to Osteoarthritis.

A person with both an ACL and meniscal injury is at a higher risk of developing osteoarthritis. Osteoarthritis is a form of arthritis that occurs when the protective cartilage that cushions the bones, wears off with time. This can happen in the hands, knee, hips, and spine.

  1. An untreated ACL injury can cause muscle wastage.

When an ACL injury is not treated for a long time, it can cause muscle atrophy, a condition where the muscles waste away. When there is an ACL injury, there is a decrease in muscle mass due to a lack of physical activity. This condition is known as muscle wastage or muscle loss or muscle withering. 


When you suffer from muscle wastage, the arm/ feet/ leg may noticeably become thinner and smaller than the other. Muscle wastage due to ACL tear may impair the normal functioning and morphology of the knee, along with strength loss and muscle atrophy of the knee extensor muscles. The reduction in muscle size in people with an ACL injury is accompanied by an 8–37% lower knee extensor strength.

A delay in ACL surgery for more than 12 weeks can lead to:

– A 3-fold increase in patella trochlear injuries.

– A 4-fold increase in irreparable tears of the meniscus.

– An 11-fold increase in lateral compartment chondral injuries.

– Significant instability of the knee.


How long should a patient wait before an ACL surgery?

Many people who want to wait before deciding to undergo an ACL surgery. Ideally, no person is advised to delay the surgery; doing so may contribute to meniscal tears. A delay of more than six months can cause degeneration of the knee and lead to permanent damage. If the injured person is aged (above 45 years) or his/her daily activities involve constant movement from one place to another, then the person should consider surgery (ACL reconstruction) even at the earliest. If at all a person decides to wait or delay the surgery, he or she should consider activity modification. 

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