Treatment Options for Anterior Cruciate Ligament (ACL) Tear

A healthcare professional examines a patient's knee while seated in a clinical setting.

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The anterior cruciate ligament (ACL) is a key structure in the knee that stabilises the joint during movement. Tears in the ACL often result from sudden twisting motions, high-impact sports, or direct trauma. These injuries can affect knee function and may require medical intervention to restore mobility. This article provides an overview of ACL tears and explores treatment methods, including surgical and non-surgical approaches.

What Is an ACL Tear?

An ACL tear occurs when the anterior cruciate ligament, which connects the thigh bone (femur) to the shinbone (tibia), is stretched beyond its capacity or torn. ACL injuries are categorised based on their severity:

Grade 1 (Mild Stretching): The ligament is overstretched but remains intact.
Grade 2 (Partial Tear): The ligament is partially torn, leading to some instability in the knee.
Grade 3 (Complete Tear): The ligament is completely torn, often resulting in significant knee instability and loss of function.

ACL tears are commonly linked to sports requiring quick direction changes, such as football, basketball, or skiing.

Treatment Approaches

Non-Surgical Treatment

Rest, Ice, Compression, and Elevation (RICE)
RICE is a first-line treatment option to manage symptoms immediately after an ACL injury. Rest prevents further strain on the ligament and promotes initial healing, while applying ice helps reduce swelling and alleviate pain. Compression, using an elastic bandage, minimises swelling and provides basic stabilisation for the knee. Elevating the knee above heart level further helps decrease fluid build-up and improve circulation. RICE is typically used in the early stages of injury management and is often combined with other therapies.

Physical Therapy
Physical therapy focuses on restoring knee strength, stability, and mobility without surgery. A tailored programme typically includes exercises to strengthen the quadriceps and hamstrings, which support knee stability. Balance and coordination training are often included to improve overall joint control and reduce the likelihood of re-injury. For individuals with partial ACL tears or less physically demanding lifestyles, physical therapy may be sufficient to restore functional mobility and avoid surgical intervention.

Knee Bracing
Knee braces provide external support to the injured joint, limiting excessive movement that could worsen the injury. Braces are often used during low-impact activities or everyday tasks to stabilise the knee while the ligament heals. They are frequently paired with physical therapy to optimise recovery. Although braces do not repair the ligament itself, they can help manage symptoms and improve confidence during movement.

Surgical Treatment

ACL Reconstruction
Surgical reconstruction is the most common procedure for addressing complete ACL tears or persistent knee instability that does not respond to non-surgical methods. The damaged ligament is replaced with a graft to restore knee stability and function. Graft options include autografts, where tissue is harvested from the patient’s own body (commonly the patellar tendon, hamstring tendon, or quadriceps tendon), and allografts, which use donor tissue in cases where an autograft is unsuitable, such as for older patients or those with multiple injuries.

This procedure restores joint stability, enabling patients to return to physical activities or sports, and minimises the risk of long-term complications such as cartilage damage or osteoarthritis.

When to Seek Medical Attention

Seek medical attention if you experience a popping sensation in the knee, swelling, difficulty bearing weight, or a sense of instability during movement. Early diagnosis and appropriate treatment are necessary to prevent additional joint damage and aid recovery.

Conclusion

ACL tears can be addressed with a variety of non-surgical and surgical treatments, depending on the severity of the injury and the individual’s lifestyle needs. Non-surgical methods, including RICE, physical therapy, and bracing, may be suitable for partial tears or less active individuals. For complete tears or those seeking to return to high-impact activities, ACL reconstruction offers a reliable solution. Consulting a healthcare provider is the best way to determine the most suitable treatment plan.

If you suspect an ACL tear, schedule a consultation today to explore your options and begin your recovery journey.

Dr. Ambrose Yung

Specialist Orthopaedic Hip & Knee Surgeon

Dr Ambrose Yung Wai Yin is a Senior Orthopaedic Hip & Knee Surgeon with over 20 years of experience in the field of orthopaedics.

Areas of Expertise:

Knee Surgery: Complex procedures like revision knee arthroplasty, partial knee replacement, and primary total knee replacement.
Minimally Invasive Surgery: Shoulder, ankle, and knee surgeries with minimal scarring and quicker recovery times.
Limb Reconstruction: Specialized in both upper and lower limb reconstruction.

Computer-guided Knee Replacement: Dr. Yung trained at the prestigious Oxford University Hospital in the UK, where he specialized in computer-guided partial and total knee replacements.

Dr. Chee Kin Ghee

Specialist Hand & Orthopaedic Surgeon

Dr Chee Kin Ghee is a specialist hand surgeon with over 20 years of experience in hand and orthopaedic surgery.

His clinical expertise includes treatments for complex hand, wrist, and upper limbs injuries, wrist and finger joint replacement, minimally invasive hand and wrist surgery, and nerve compression release surgery

Dr Chee was awarded a 1-year fellowship (HMDP by MOH) & trained at world-renowned Wrightington Hospital Upper Limb Unit, UK.
He was trained in the management of complex upper limb conditions, including complex joint replacement of the shoulder, elbow, wrist, and hand, as well as modern minimally invasive upper limb surgery.

Dr. Low Mun Hon

Dr Low Mun Hon has over 20 years of experience managing trauma and orthopaedic clinical care. Prior to this, he has been in private practise as a practitioner at Singapore Sports & Orthopaedic Clinic (SSOC).

Dr. Low graduated from Monash University Medical School (Melbourne). Thereafter, he pursued his internship at The Alfred Hospital in Melbourne.

He subsequently continued his practice of medicine at Singapore General Hospital (SGH). During this period, he was awarded the membership of the Royal College of Physicians and Surgeons at Glasgow in 2008 & Master of Medicine in Orthopaedic Surgery (National University of Singapore) in the same year.
Dr Low had previously worked as an orthopaedic trainee at various local teaching hospitals i.e. Ng Teng Fong General Hospital (NTFGH), Tan Tock Seng Hospital (TTSH), KK Women’s and Children’s Hospital (KK Hospital) and Singapore General Hospital (SGH).

Justin Lim Xuan Li

Physiotherapist

Justin is a skilled and experienced physiotherapist who specializes in the treatment of neuro-musculoskeletal conditions (nerve, muscle and joint).

Over the years, he honed his clinical skills across all sectors of healthcare, allowing him to attain mastery of the sophisticated human body and address complex problems effectively, allowing him to successfully address complex neuro-musculoskeletal conditions at an accelerated pace.

Justin graduated from Trinity College Dublin and started his career in National Healthcare Group Polyclinics. His skills quickly gained recognition and was appointed as a clinical educator for physiotherapy students and even tasked to develop Clinical Practice Guidelines.
Subsequently, he continued his practice in community care settings such as Thye Hwa Kwan Rehabilitation Centres and Saint Andrew Community Hospital, where he focused on developing his skills for geriatric rehabilitation and improving quality of care in rehabilitation centres. He then moved on to private practice in Parkway East Hospital, specializing in post operative and outpatient rehabilitation.

Chan Jing Cheng (JC)

Physiotherapist

JC has over 12 years of experience in treating Chronic pain, Orthopaedic and Geriatric conditions.

He had worked at various Private Hospitals, Singapore General Hospital, NTUC Health Elder Care and Lions Home for the Elders.
He is passionate about solving complex musculoskeletal disorders and helping clients relief pain from trauma and illness.
He has a special interest in the Shoulder, Spine, Hip and Knee joint conditions.
He has helped thousands of clients go through rehabilitation smoothly and achieved higher satisfaction after orthopaedic surgery.

Zita Sham

Physiotherapist

Zita graduated with a Diploma in Physiotherapy from Nanyang Polytechnic (Singapore) in 2014 and started working in Ng Teng Fong General Hospital to serve her sponsorship bond.

Later in 2015, she pursued a Bachelor’s Degree in Physiotherapy from Trinity College Dublin, which was provided in Singapore Institute of Technology.

After completion of her studies, Zita worked in the Day Rehabilitation Centre in Jurong Community Hospital for 6 years, where she focused on community rehabilitation for a variety of patients. Patients that were mainly seen consisted of post-operative, geriatric and neurological conditions.
Zita also has a passion in musculoskeletal and sports physiotherapy and is looking to pursue that. She is also keen to provide home-based physiotherapy to reach out to those in need of her expertise.

Joanna Lim

Hand Occupational Therapy

Joanna’s primary specialization and passion is in hand therapy and upper limb rehabilitation, having more than 10 years of experience in this field.

Joanna obtained her Diploma in Occupational Therapy (Merit) from Nanyang Polytechnic in 2006. Under the MOH Health Science Scholarship, she graduated from La Trobe University, Australia, with a Bachelor’s degree in Occupational Therapy (1st class Honors) the following year. Upon graduation, she worked in Changi General Hospital and Sengkang General Hospital.

She has worked with hand and orthopedic surgeons in both inpatient and outpatient settings, providing quality therapy services for clients with a variety of hand and upper limb conditions, including fractures, sprains/strains, tendon injuries, nerve injuries, repetitive strain disorders and complex trauma injuries.
During her tenures at CGH and SKGH, Joanna was a Senior Occupational Therapist and held the role of Hand Therapy and Upper Limb Rehabilitation Unit Leader. She was in charge of clinical supervision and management of staff, manpower planning, and daily operations of the unit.