ACL injuries or Knee ligament injuries are seen commonly by the best orthopedists in town, as these injuries often times occur in aggressive or elite level San Diego athletes that yearn to return to play.


Anterior Cruciate Ligament (ACL) injuries or simply ACL injuries happen to hundreds of thousands of people every year.  ACL  injuries usually end play and can be extraordinarily painful. Although debilitating, they are treatable. You just have to make sure you know how severe your injury is and what you can do to treat the problem.bruised-knee-contusion

ACL injuries are actually quite common among people who participate in high action cutting sports, such as:

  • Soccer
  • Football
  • Basketball
  • Lacrosse

Levels of Severity with ACL Injuries

There are three categories of injuries based on what kind of damage has been done to the ACL:

  1. Grade 1 ACL injuries: This is the easiest ACL injury to heal. A grade one ACL injury is the result of the ligament stretching slightly. It does not cause the knee joint to become unstable.
  2. Grade 2 ACL injuries: This grade of injury is in the middle, and the least common of all knee injuries. A grade two type of injury happens when the ligament stretches to the point where it is unstable. It is more commonly known as a partial tear.
  3. Grade 3 ACL injuries: This ACL injury is the most severe. A grade three injury is labeled when the ligament is completely torn in half. This can cause the knee to become extremely unstable. Severe knee pain and an almost impossible time walking are common symptoms.


At the end of the day, the grade doesn’t really matter.  To an orthopedist this injury boils down to those athletes that are able to compensate (ie, their knee is functionally stable) and those that can’t (ie, their knee is functionally unstable). Having a functionally stable knee means that that athlete is able to return to his/her level of customary play in cutting sports without the knee giving out.  Generally speaking, one third of athletes will be able to return to play despite their injury with little to no intervention; one third of athletes will be able to return to play after engaging in directed physical therapy without surgery; one third will require surgery in order to return to play due to continued knee instability despite physical therapy.

Treatments for ACL injuries

Non-Severe ACL Injuries

If you only have a mild injury, you can, usually, use physical therapy to treat your injuries. Your physical therapist will have you go through a series of exercises and motions to help you regain full control of your knee again. It can take some time to heal completely, depending on the injury type.

Since this is so common with sports athletes, there are specialists who work specifically with athletes. The goal is to help them get back into their sport of choice as quickly as possible.

Severe ACL Injuries (ie, unstable knee)

One third of the athletes will require surgery to regain a stable knee, despite having engaged in physical therapy.  With a physical examination and an MRI scan, a well-trained sports medicine surgeon can anticipate the need for treatment of various concomitant injuries: cartilage damage, meniscus tears, etc.  severe-acl-tear

ACL reconstruction can be done in a variety of ways.  First decision to be made is whether a patient chooses to use their own tissue or donor tissue to reconstruct the ligament.  If a patient chooses their own tissue, the options are bone-patellar tendon-bone, or hamstring tendon, or quadriceps tendon.  Although some surgeons may argue that one type of tissue is superior to the other, many studies have looked at this and there is little to no clinical difference.

If you have been told that you have an ACL tear or are concerned about a knee injury, contact our award winning sports medicine doctors at San Diego Orthopedic Surgery Clinic.



Many of our Carlsbad and North County San Diego competitive soccer players sustain ACL tear every year.  Even though, sports medicine specialists take measures to prevent such devastating knee injuries, a twisting injury to the knee suffered by the Arizona Cardinals’ Darnell Dockett is just the latest ACL tear to sideline a professional athlete.acl-tear

ESPN reported that Dockett, a defensive tackle, damaged the knee when his foot caught in the turf during training camp in Tempe, Ariz. Following an examination, doctors scheduled Dockett for surgery. Just a few days earlier, Rams quarterback Sam Bradford sustained an ACL tear  as a result of a hard hit by a defensive lineman. Both players are out for the season.  The risk of sustaining such knee injuries and other ligament tears are somewhat preventable with proper core strengthening.  acl-tear-knee-injury

ACL is short for anterior cruciate ligament, connective tissue that extends from beneath the femur (thigh bone) to the top of the tibia (the large bone in the lower leg). The smallest of the four main ligaments in the knee, it stabilizes the knee for rotational movements. The ACL enables a person to make fast “cuts” while running. It is rarely stressed during activities like jogging that do not involve sudden stops, twists or turns.

ACL tear and sprains were once referred to as “trick knees.” They occur frequently in football, basketball, soccer and tennis because of the pressure and repetitive stress that athletes put on their knees. Most of the 250,000 to 300,000 ACL tear injuries reported in the United States each year involve people who play sports. The odds of an athlete spraining or tearing an ACL reportedly is about 1,000 to 1.

ACL Tear Types:

A Grade 1 ACL tear features a ligament that has been stretched too far. It does not usually prevent normal use of the knee. A Grade 2 sprain results from the ligament being stretched to the point that it is loose. This condition also is called a partial tear. The most serious ACL tear injury, a Grade 3 sprain, is a complete tear, in which the ligament is severed and the knee becomes unstable.acl-tear-grades

The ways that Dockett and Bradford hurt their knees were typical. ACL tears result from changing direction too quickly or stopping suddenly, landing wrong on the knee after jumping, and the blunt-force trauma of a blow to the joint or a collision. When an ACL tear occurs, the person might hear a popping sound in the knee. The joint gives out and quickly becomes inflamed. This causes a great deal of pain, as well as loss of mobility and range of motion.

While a mild sprain sometimes heals without surgery, an ACL tear must be repaired for a patient to regain full use of the knee. It is not possible to merely stitch back together the two pieces of a severed ligament. Orthopedic surgeons reconstruct ACLs by grafting tissue from the patellar tendon (with attaches the kneecap to the shine bone), the hamstring tendons (in the back of the thigh) or the quadriceps tendon (which runs from the kneecap to the thigh). Tissues from cadavers also are used.

The arthroscopic procedure requires only small incisions in the skin. Surgeons insert miniature instruments, which they manipulate to graft the tissues. Patients experience less pain, and recover more quickly, than they would if more invasive surgery were needed. Sometimes, ACL injuries happen in conjunction with damage to other ligaments or cartilage. That can necessitate more extensive surgical procedures.  You don’t have to live with the knee pain and instability.  Contact our Orthopedic Surgery San Diego Sports Medicine specialists to help you regain your mobility and be the best athlete you can be.



One of the most common sports related injuries is a torn ACL (Anterior Cruciate Ligament). Many people think that ACL injuries happen mostly in contact sports but the truth is that a majority of ACL injuries occur without contact. One example of a non-contact ACL injury was during a recent major league baseball game. Los Angeles Dodgers pitcher Paul Maholm ran to cover first base on a relatively routine ground ball. Maholm arrived at first, planted the toes of his right foot on the edge of the bag and then went down riving in pain and reaching for his right knee. After watching the replay about a dozen times it is still hard to say that anything even truly happened. However, within a day it was confirmed that Maholm had a complete ACL tear. A simple misstep and his whole season is over.

The ACL is one of four major ligaments that help to align and stabilize the knee. The knee is the point at which thighbone (femur), shinbone (tibia), and kneecap (patella) meet. The ACL attaches the center of the kneecap to the front of the shinbone. The function of the ACL is to assure proper alignment of the shinbone and thighbone. In addition, the ACL provides very important rotational stability. Like many other ligament injuries, ACL injuries can be diagnosed by severity. Grade 1 ACL sprains are considered mild and involve the ACL being stretched but not detached. With grade 1 ACL sprains, the ACL is still capable of stabilizing the knee joint. Grade 2 ACL sprains are moderate or partial tears and occurs when the ACL is stretched to the point of becoming loose. Grade 3 ACL sprains are the most severe of the ACL injuries. Grade 3 ACL sprains occur when the ACL is completely torn into two separate pieces making the knee joint very unstable.

Grade 1 and some grade 2 ACL sprains can often be treated without surgery as long as instability symptoms are at a minimum. The process of healing involves a heavy regimen of progressive physical therapy but can often restore the ACL close to its pre-injury form. For a more severe tear or what is called a ‘complete tear’, surgical reconstruction is the only way to achieve pre-injury form if there are symptoms of instability. Instability is when the knee gives away or buckles. The ACL is replaced using a tendon graft typically from the patient’s patellar tendon, hamstring tendon, quadriceps tendon, or from various cadaver tendons. The success rate of ACL replacement is tremendous and many athletes come back after surgery and rehabilitation to perform similar to their pre-injury performance. One such example of this was Minnesota Vikings running back Adrian Peterson. Peterson nearly broke the NFL rushing record just one year after suffering a complete tear of his ACL and MCL.

As for the case of Paul Maholm, his surgery has not yet been scheduled, but should be scheduled soon. Given the recent success of professional athletes on surgically replaced ACLs, I have no doubt that we will see Paul Maholm on the mound for the start of the 2015 season.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow