Josh is an active runner, tennis player, and outdoors fanatic. He loves being active and doesn’t let anything slow him down. During an intense tennis doubles game, Josh landed after delivering an amazing return and felt a pop in his left knee. Suddenly, his knee buckled and Josh was down. Within a few minutes, the pain was worse and his knee began to swell up. Josh could hardly walk. At first, Josh thought he could continue on without any problems but it became apparent that he needed additional help.

Josh visited an orthopaedic surgeon and learned that he had torn his anterior cruciate ligament (ACL). 

What does the ACL do?

The knee is made up of four bones that come together: the fibula, tibia, and femur. The patella bone, or kneecap, sits on top to provide protection.

Ligaments in the knee act as a brace that hold everything together. The anterior cruciate ligament that Josh tore in our story above is responsible for the backward, forward, and rotational motions of the knee. In fact, the ACL provides 85% of the stability to the knee.



How can you tell it’s an ACL injury?

The ACL can be torn or sprained in three different ways. These sprains are graded on a severity scale ranging 1-3.

Grade 1: In this type of injury, the ligament is only mildly damaged or stretched, but can still keep the knee stable.

Grade 2: The ligament at this level stretches and becomes loose. This type often results in an unstable knee.

Grade 3: This type of injury is a complete tear of the ligament, causing it to be tear in two. This is the most common type of ACL injury.

Josh’s experience would put him in the Grade 3 category, meaning his entire ligament was torn and the knee joint is unstable.

What causes ACL tears and what are the symptoms?

Some of the causes for ACL tears are:

  • Changing direction rapidly
  • Suddenly stopping
  • Landing from a jump incorrectly
  • Direct contact or collision (football tackle)
  • Car accidents

Female athletes have a higher risk for ACL injury, in fact the ratio is 6-1, female to male.

Josh experienced some of the typical symptoms of an ACL tear:

  • Knee popping pain
  • Instability of the knee when turning and twisting
  • Loss of full range of motion
  • Tenderness along the joint
  • Discomfort while walking
  • Swelling in the knee

What Are the Treatment Options?

There are a few treatment options for ACL injuries, including nonsurgical and surgical options.


Most ACL injured knees will not be functional on their own, without surgery. For a non-surgical approach,  Dr. Keith recommends bracing and physical therapy to ease the pain and bring the knee back to full range of motion and function for as much stability as possible.  


ACL’s, for the most part, cannot be stitched back together. Dr. Keith will replace the torn ligament with a tissue graft. Recovery time with surgical procedures varies for each person, but ACL surgery typically takes 4-6 months to recover from. Improvement will continue for upwards of a year.

Whether surgical or non-surgical means are used, rehabilitation is an important step in getting back to your daily activities.

What next?

Josh visits Dr. Keith and is able to get the help he needs. Josh follows the physical therapy protocol diligently and efficiently. After a certain amount of time, he is able to enjoy running and tennis again. Josh, like most people, is able to return to his desired level of physical activity. ACL injuries are never a fun thing to experience, but with Dr. Keith’s experience and expertise, he’ll have you back on your feet in no time.