ACL Injury – Nemanja Vidić

Feb 25, 2012
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In sports that require much twisting/turning and changing direction, a complete tear (rupture) to the Anterior Cruciate Ligament (ACL) is a commonly sustained injury to the knee. A recent example of this injury at an elite/professional sporting level is that of football’s Nemanja Vidić, central defender and captain of Manchester United, who suffered an ACL rupture during United’s Champions League defeat to FC Basel in early December 2011. This blog will take an in-depth look at where the ACL is and what it does, how an ACL rupture occurs and what the key symptoms are, how it is diagnosed and how it can be treated.


Where is the ACL? What does it do?

The ACL attaches the shin bone (tibia) to the thigh bone (femur) and sits deep within the knee joint. It acts to ensure the tibia does not move too far forward in front of the femur, also preventing too much rotation of the knee joint itself, which gives the ACL a key function of maintaining stability within the knee.


How can I rupture my ACL?

ACL ruptures can arise in several different ways; in sports such as football, basketball, skiing and gymnastics, the most common cause is twisting a partially-bent knee after landing from a jump, or landing on an over-extended knee.

© / A.D.A.M

Direct impact to the knee when the foot is planted in sports such as American football and rugby can also cause this injury; other methods include suddenly stopping when running, and sudden transfer of weight from one leg to another.  It is very common for other knee injuries to occur at the same time as an ACL rupture due to the mechanism of injury. The most likely injuries that happen alongside ACL damage are tears to the knee cartilage (meniscus) and the Medial Collateral Ligament (MCL), and together are known as the ‘unhappy triad’! Other combinations of knee injuries exist depending on the cause; a large impact to the inside of the knee may rupture the Lateral Collateral Ligament (LCL), with a stronger force causing the ACL and, in severe cases, the Posterior Cruciate Ligament (PCL) to rupture also.


What are the symptoms of an ACL rupture?

At the time of injury: The player may hear and/or feel a ‘snap’ deep down in the knee joint followed by severe pain. The player will not be able to continue to play their sport due to the pain and the immediate instability to the knee – see ‘Where is the ACL? What does it do?

Injury + 2 Hours (approx): The player’s knee may become very swollen; however, this is not always the case. Strangely enough, even though there has been extensive damage to the knee joint, the player is usually pain free at this stage. This is because the nerve innovation of the ACL has been severed and therefore the brain does not get sent the message of pain; some people have even admitted to having a night out on the town the night of the injury!   Due to the rupture of the ACL the stability of the knee is vastly reduced. This means, even though a player may not feel any pain when they start doing activities like twisting to cross a ball or changing direction to side-step an opponent the knee can very often ‘give way’.


How is an ACL rupture diagnosed?

At Physio 1st, we see ACL injuries at different stages; some as they happen at pitch-side, some a few days later, and some even years after the initial injury. In each case, the assessment process is very similar. The subjective history is the most useful tool in a physiotherapist’s arsenal when it comes to diagnosing an ACL injury – this is why we ask so many questions! There are a number of tests that can be used to determine an ACL injury:

  • Stress tests on the knee ligaments: The therapist can apply pressure at different angles to the knee joint, with the degree of movement at the joint (laxity) compared to the uninjured side used to indicate an ACL injury. For the ACL, the most commonly used  stress test is the Anterior Drawer Test.
  • Scans/Investigations: an MRI (magnetic resonance imaging) scan is the preferred choice of investigation if an ACL rupture is suspected.

However, should the scan generate an unclear image, an arthroscopy can be used to examine the joint directly; this involves inserting a small tube with a camera one end that transmits an image through to a TV monitor, and can help identify the cause of the pain, swelling, tenderness and/or weakness.


How is an ACL rupture treated?

Treatment for an ACL rupture is usually managed with Surgery. The surgeon will normally take a tissue graft from the hamstring or the patella tendon and use this to create a ‘new’ ACL.

© ADAM /
© ADAM /

Following surgery, intensive physiotherapy is needed. This rehabilitation process usually takes around 6 months to complete. That is why Nemanja Vidić is not due to return for Manchester United in June 2012.


Images © Evening News