The ACL ligament is located in the center of the knee joint where it runs from the backside of the femur (thighbone) to connect to the front of the tibia (shinbone).

The ACL is the main controller of how far forward the tibia moves under the femur. If the tibia moves too far, the ACL can rupture. Sports, that require the foot to be planted and the body direction to be changing rapidly, frequently result in ACL tear.

Symptoms following a tear of the ACL can vary. People may hear a loud pop when the ligament is torn, and feel that the knee gives way. The knee may feel like it wants to slip backwards. Usually, the knee joint swells up due to bleeding into the knee joint from torn blood vessels in the damaged ligament. Knee movements and walking become limited and painful.

Non-surgical rehabilitation for a torn ACL will typically last six to eight weeks. Physical therapy consisting of electrical stimulation and ice reduce pain and swelling. Exercises to improve knee range of motion and strength are added gradually. A special knee brace may be of value.



The knee cap, or patella is embedded in the quadriceps tendon. The patella enhances knee movements by providing gliding action to the quadriceps tendon, during knee extension and flexion, as it is tracking in the groove of the femoral condyle.

If the thigh and the leg has an abnormal angle, at knee extension, a weak quadriceps muscle will be unable to keep the patella in the groove. This "mechanical failure" causes maltracking due to misalignment, and it derails the patella from its correct anatomical movement track at every quadriceps contraction .

The resulting pathological rubbing and friction caused by the sharp edges of the femoral condyle, roughens and scratches the under-surface of the patella. Knee movements, (walking and stair climbing) become painful.

In early stages, treatment is conservative consisting of physical therapy. With the help of ultrasound new tissue formation can fill the scratches. The effects are similar to a "Zamboni" ice machine. Proper exercises restore muscle balance and prevent recurrence.

For more information or for an evaluation please call New York Midtown Orthopedics at 212-758-4688.

Remember: timely diagnosis and treatment may prevent chronic pain, surgery and permanent disability.