Can You Walk with a Torn ACL?

ACL

Can You Walk with a Torn ACL?

Can you still walk with a torn ACL? How long after ACL surgery can you walk? The ACL (anterior cruciate ligament) is a tissue that connects the thighbone to the shinbone in your knees. A torn ACL is one of the most common knee injuries experienced during exercise or sport, which involves damage to the ACL that is one of the key ligaments to help to stabilize your knees during motion.

Typically, a torn ACL is not the result of direct contact, it’s generally occurred when a sudden change in direction or pivot against a locked knee or it can be caused by putting repeated stress to the knee during exercise or sport which can injure the ACL or cause the ligament to lose elasticity like a stretched-out rubber band.

The ACL is responsible for providing stability to your knees, especially when you are turning, twisting and changing direction during activities. Technically speaking, you can walk without the ACL if you are only participating in straight line activities such as walking or cycling. However, if your ACL is completely torn, continue to walk may damage other parts of the knee and affect knee function for a lifetime which can lead to osteoarthritis if not treated correctly. Some people who had a torn ACL are unable to return to high-impact activities or sports without ACL reconstruction. The common symptoms for a torn ACL are experiencing pain or sore knee right after the injury but the pain will settle overtime provided that with no reinjuries. An unstable knee is the typical end result of a torn ACL that most patients have experienced instead of a painful knee.

1. Torn ACL Fundamentals: Symptoms, Causes and Diagnosis

A torn ACL is the tearing or over-stretching of the ACL in the knee. You might wonder where is the ACL located and what does an ACL injury looks like? The ACL sits in the middle of the knee. Its main job is to prevent the shinbone from sliding in front of the thighbone. ACL is the primary restraint to forward movement of the tibia (shinbone). Without the ACL, your knee joint might be wobble and tend to have dislocation. The ACL prevents the tibia from sliding too far forward. 

ACL pain location

Where is your ACL? The following chart has illustrated the difference between a normal ACL and a torn ACL as well as where does the tear occur. As can be seen in the following chart, the ACL is located in the middle of the knee, and it can be partially torn with partial tearing of the ligament or completely torn when the ligament becomes detached to cause pain in the center of your knee during an ACL tear.

What-Does-An-ACL-Injury-Look-Like

Torn ACL symptoms

According to orthopedic surgeon Mr Benjamin Witte of Orthopaedics from WA. There are five common symptoms of a torn ACL:

  1. Knee pain - pain can be severe enough to make walking or weight-bearing difficult
  2. Swelling - the knee joint can begin to swell within a few hours after the injury because there is bleeding and blood will collect in the knee
  3. Knee instability - the knee can feel loose and causing a sensation of instability when it is weight-bearing, twisting or side-to-side movements
  4. Clicking/clunking - feel a “popping” or “clicking" sensation or even hear a “pop” when an ACL is torn
  5. Knee gives way - having trouble to return to sport especially when turning and twisting

ACL-symptoms

We highly recommend patients who have experienced more than 2 symptoms above to contact the doctor immediately to do a physical examination or MRI to diagnose accurately.

Since many symptoms for a torn ACL is very general across different knee injuries and it's not necessarily related to a torn ACL. Many people were wondering if any signs or feelings that are commonly associated with a torn ACL. The following sections have covered the feeling and signs of having a torn ACL.

How to know if you tore your ACL?

How to tell if you tore your ACL? Generally speaking, you might experience a popping sound or sensation in the moment of injury followed by knee pain and swelling are the most common symptoms of you tore your ACL. Your knees may also be unstable and unable to continue physical activity after the injury.

If you also experience the swelling in the knee is rapid after injury and loss of range of motion, chances are you have a torn ACL, and you should seek immediate care and get a prompt and accurate diagnosis like MRI to determine the severity of the injury.

What does a torn ACL feel like?

You might wonder what do you feel when you tear your ACL? When the ACL is torn, the first thing you will feel is the signature loud popping sound and you might also feel intense pain followed by an ache or throbbing sensation because your knee is swelling. Within a few hours after the injury, the feeling of the pain can be sharp or moderate-to-severe pain is more common.

Torn ACL feeling

According to many torn ACL patients’ feedback, there is no one feeling that can characterize a torn ACL because everybody is different, and the severity of the injury can also be quite different. However, the majority of the patients have mentioned that they can hear a loud popping sound from the knee before they start feeling the pain. The moment after injury when they attempted to walk, the planted leg gave out. The paint might be disappeared after a few seconds or an hour but they might experience a strange feeling that is quite different from other knee injuries, which is a combination of instability and weakness around the injured knee. Some of the patients also mentioned that it might be tough to straighten the injured leg completely.

injured-knee-soccer-player

One of the torn ACL patients who has been successfully rehabbed from a torn ACL has mentioned that he didn’t feel the popping sound that many of the other patients heard. He felt his body was going one way while his knee went in the opposite direction. The reason he didn’t experience the signature loud popping sound is probably because he didn’t actually tear the ACL. The cause can be explained in the biomechanics of the ACL which is due to plastic deformation of the collagen fibers which is causing the ACL to be stretched out too much to lead to a functional torn ACL.

If you are experiencing a third-degree ACL tear which means the ACL is torn completely in half and lost its functionality of stabilizing the knee joint. You will have an instant feeling of being unsure about the stability of your injured knee. Your knee might be given away at any time when you are walking up or downstairs.

Can you have a torn ACL while you can still walk?

Since the ACL is the primary knee stabilizer, having a torn ACL can cause a feeling of instability when you are walking or changing direction.  In the majority of cases, although a person experiences a completely torn ACL can still walking in a straight line soon after the injury, they might face a challenge to change direction. Hence if you can continue to walk after the injury does not eliminate the likelihood of having a torn ACL.

Torn ACL causes

Sports and fitness activities can be the common causes of a torn ACL. The ACL is typically injured when you are participating in sports that involve twisting and side-to-side motions, and it may occur at surprisingly low force applications. The ACL can be torn when you are making a sudden change in the direction against locked knee to stresses and damages the ligament. Generally speaking, women are more likely to experience a torn ACL because of the differences in muscle function and anatomy. Causes of ACL tears can also be summarized into 5 points:

  1. Sudden slowing or stopping from running
  2. Quickly change direction during sports
  3. The knee has suffered from repetitive stress it can cause the ACL to lose elasticity
  4. Get hit directly on the side of the knee when you are playing sports like football or basketball which can cause your knees to get hyper-extended or bend slightly inward
  5. Unexpected impact to the front of the knee which can cause backward motion of your knee joint which may cause the ACL to strain or tear

Sudden-stopping-from-running

Many patients wonder why ACL injuries are so common? There are around 200,000 ACL injuries per year in the United States. The ACL tears are more common than other ligament injuries because the joint is lack of muscle support for rotational and twisting movements. Torn ACLs seem to be more common for women than men because female tibias tend to slide backward more at rest, and women tend to have a different pattern of musculature with weaker gluteals.

Diagnosis

In this section, we are not aiming to guide you on how to diagnose a torn ACL or determine whether it’s a partially torn ACL or a completely torn ACL. You should consult your doctors for proper diagnosis with no delays if you are experiencing more than 2 symptoms discussed above. We are aiming to provide you the guidance about what you might feel if tore your ACL and when you should contact your doctor to diagnose as well as what diagnosis process you can expect to go through.

performing-knee-ultrasound

Diagnosis can be made through a physical exam to check your knee for swelling and tenderness, and your doctor will move your knee to different positions to test the range of motion and compare the injured knee against the uninjured knee. More accurate diagnoses such as X-ray, Magnetic resonance imaging (MRI), ultrasound may be required to determine the severity of the injury of the ACL. An MRI can detect the extent of an ACL and find out if any signs of damage to other tissues in your knee.

2. Can You Walk with a Torn ACL?

Many torn ACL patients want to understand whether they can walk with a torn ACL, or should they be walking with a torn ACL after the injury? To answer this question about whether you can walk with a torn ACL, we should divide this question into three main aspects:

  1. Can you walk right after an ACL injury? - Depending on the severity of the injury, the majority of the patients were able to walk right after an ACL injury but they might feel a lack of support or stability from the knee. Generally speaking, the injury may get worse or better the next day, depending on the type of ACL injury and severity. Some of the torn ACL patients have been experienced a swollen knee like a balloon and make it much more difficult to walk properly due to the inflammation. We do recommend you to see a specialist such as an orthopedic surgeon to do a proper physical examination or MRI to get an accurate diagnosis if you suspect you are having difficulties to walk after experiencing a knee injury.
  2. Can you walk after ACL surgery? - If you had an ACL reconstruction surgery, you will need crutches or a hinged knee brace to protect your knee and provide knee support when you are walking. You should avoid putting your full weight on the repaired leg during the first 2-3 weeks after ACL surgery. Physical therapy will often begin about 1-2 weeks after surgery to start with some simple postoperative knee exercises.
  3. How long after ACL surgery can you walk? - You might wonder how long are you on crutches after ACL surgery. You may be able to start walking by putting your full weight on the repaired leg without relying on crutches or knee brace around 2-3 weeks after surgery. You might also wonder when you can return to sport after ACL surgery. Generally speaking, it will take 4-6 months for you to regain full control of your required knee to participate in sports again.

Research Study about returning to walk or sport after ACL surgery

According to a retrospective study about returning to sports after ACL reconstruction in amateur athletes in 2016, out of a group of 80 amateur athletes, 47.5% of them were able to return to sports activities on an average of 8 months after ACL reconstruction surgery.

We have analyzed the data from the retrospective study and calculated the percentage of athletes returned to sports by the type of sports and sorted the percentages in ascending order. We can clearly see that 38 out of 80 (47.5%) amateur athletes at the time of the report had returned to sports. It is worth mentioning that soccer is a high impact sport, 54 athletes were able to play soccer before ACL surgery but only 14 out of 54 (25.9%) of them can return to soccer. In contrast, 8 of 10 (80%) athletes were able to return to athletics, which is much higher than the overall percentage at 47.5%. The sample sizes for the rest of the sports are relatively too small to comment on that at the time of the report.

Percentage of athletes returned to sports by the type of sports

Sports Pre-surgery Post-surgery Percentage of athletes returned to sports
Jogging 2 0 0.0%
Cycling 2 0 0.0%
Soccer 54 14 25.9%
Basketball 2 1 50.0%
Athletics 10 8 80.0%
Running 4 5 125.0%
Volleyball 3 5 166.7%
Tennis 3 5 166.7%
Total 80 38 47.5%

 

Additionally, the study also categorized the data based on the sports competitive level. The study has found that it was a relatively inverse relationship between the competitive level and the percentage change of athletes returned to sports. Higher sports competitive levels are having a relatively lower percentage of athletes that was able to return to these sports.

The competitive level according to Tegner activity score is a commonly used patient-administered activity rating system for patients with knee disorders. It’s a numerical scale ranging from an activity level on a scale of 0 to 10. Zero represents disability due to knee problems, 10 represents competitive sports on a professional level. Range 5 to 8 will be chosen for this study based on the group of 80 athletes after ACL reconstruction. The definitions of different competitive levels for sports or activities have been listed below:

  • Level ≤ 5 activity: work-light labor, work sedentary activity or recreational sports
  • Level = 6 activity: recreational sports at least 5 times per week
  • Level = 7 activity: competitive or recreational sport
  • Level = 8 activity: competitive sport

As can be seen in the following table and chart, it has listed the percentage of athletes who can perform sports or activities at each level before or after ACL reconstruction. Apparently, the percentage of athletes who can return sports or activities at level ≤ 5 after ACL surgery is 50% which is 45% more than the percentage before the surgery. However, the percentage of athletes who can return to level 7 sports or activities has decreased significantly. It confirms the inverse relationship between the competitive level and the percentage of people who were able to return to sports or activities in each activity level. In a simple word, you will have less chance to return to highly-competitive sports or activities after ACL reconstruction, while some patients were able to fully recover eventually.

Percentage of athletes returned to sports by competitive levels

Sports competitive level Pre-surgery Post-surgery Percentage change of athletes returned to sports
Level ≤ 5 5% 50% 45.0%
Level 6 7.5% 12.5% 5.0%
Level 7 75.0% 27.5% -47.5%
Level 8 12.5% 10% -2.5%

 

Percentage-Change-of-Athletes-Returned-to-Sports

After analyzing the possibility of returning to sports or activities after ACL reconstruction, whether you can walk with a torn ACL becomes a much easier question to answer because walking has much less complexity in terms of the movements and risk of injury. If we use the number 47.5% of people who were able to return to sports from the above study as a benchmark, we would expect the percentage of people who can go back to walk after ACL reconstruction to be much higher than 47.5%. Actually, majority torn ACL patients will eventually go back to walk normally and be able to put full body weight on repaired leg around 4-6 weeks after the surgery. According to orthopedic surgeon Mr Benjamin Witte, surprisingly for many patients, they can often get back to walking and they feel ok.

Naveen Sharma, the consultant orthopedic and arthroscopic surgeon in Jaipur, has also mentioned that many of the torn ACL patients are able to walk after the injury but they might feel loose knee in the first a few days. The swelling and pain can be improved depending on the severity of the injury. Sometimes the X-ray result will indicate that the bone is normal, but this can be the false assurance because the knee is not getting sufficient support, especially when the patients are walking on uneven grounds or stairs. Torn ACL patients might be able to walk but generally cannot run, the leg and thigh on the injured side will become thin over time because they try to walk by putting pressure on the other side.

Patients' experiences about whether they can walk with a torn ACL?

PowerRebound.com has conducted a research in 2020 to survey a sample group of 70 torn ACL patients anonymously to understand what do they feel when they tear their ACL and whether they can walk after the injury or surgery. The research has summarized the most frequent keywords from the survey responses in word clouds and showcased 5 patients’ representative survey responses (out of 66 valid responses).

The main purpose of the survey is to understand whether people can walk with a torn ACL from a patient’s perspective because they are a group of people who have truly experienced a torn ACL. The survey is also aiming to help patients with a torn ACL to understand whether the severity of their injuries is worse or better than the average so they can take action accordingly. Let’s start by reviewing the word clouds to see what’s the most frequent words from 66 valid survey responses to get a quick high-level overview of what’s patients’ thoughts about walk with a torn ACL:

Survey-Responses-Word-Clouds

As can be seen in the word clouds, the most frequent words from torn ACL patients’ responses are 'Yes', “Torn”, “ACL” and “Walk”. Since “Torn” and “ACL” are just the keywords from the survey question which we can exclude it from the results. The keywords: “Yes” and “Walk” represent the most frequent survey answers from the responses. The pie chart indicates that the percentage of responses that can be categorized under answers: “Yes, I can walk with a torn ACl” and “No, I can’t walk with a torn ACL”. Therefore only 7% of torn ACL patients have mentioned that they can’t walk properly with a torn ACL. In comparison, the majority (93%) of the torn ACL patients indicated they could walk with a torn ACL after injury or surgery (some of them require support from knee brace or crutches to walk).

Now let’s review some representative survey responses to understand what torn ACL patients actually said about whether they can walk with a torn ACL:

Patient A: “My story is kinda funny. I have never thought that i torn my ACL at all! I keep strengthening it and work hard! I played basketball with it for 5 years without any support and it was totally fine. Not until we had the money to do the MRI when I found out that my ACL is torn.”

Patient B: “Yes, however if it is truly torn, you risk damaging other parts of the knee should the joint give way. It’s recommended that you wear a brace to prevent this collateral damage, and do PT to get all parts of the leg/hip/butt strong to support the knee.”

Patient C: “Immediately after tearing mine I couldn’t walk, as my knee just collapsed and I fell over each time I tried (at the time I was thinking “if I can walk, I can go back on the field. With a little rest I was able to start weight bearing and then walking again. I waited nearly 2 years for my first surgery, and then put off my second for another 10 years, and was able to walk fine.”

Patient D: “I totally snapped mine and had a 3 week jungle adventure in Borneo paid for, not the best timing but I got a great brace do there was support. I walked everyday for hours and was okay. Painful at times but okay”

Patient E: “Depends on how bad it is, I tore mines Feb.23, I had surgery Mar.29 and I still can't walk, Can't take a single step, Everyone's injury is different. I'm on crutches still”

As we are going through the most representative responses, we have discovered that most of the patients were able to walk or to rely on a walker to walk after the ACL injury. Some people like patient A did not suffer any pain, and she may not even notice that she had a torn ACL until she got a chance to do the MRI after playing basketball for 5 years. While some other patients like patient D do mentioned, they have experienced pain after ACL injury. So as many orthopedic surgeons suggested: “a torn ACL can be very different circumstances for different people, pain is not a good indicator of the severity of the ACL injury.”

FAQs about walking with a torn ACL

torn-ACL-FAQ

Will walking exaggerated my torn ACL?

Walking can be dangerous right after the injury and may cause damage to other parts of your injured knee. You should see your doctor to make a proper diagnosis to understand the situation before returning to walk. If your surgeon allows you to walk after the diagnosis, you should walk carefully to avoid turning and twisting on the knee and try to walk in a straight line during the 1-2 weeks after the injury. In most of cases, if you follow your surgeon’s instructions properly, walking after ACL injuries should not make it worse.

Is it painful to walk with a torn ACL?

Does it hurt to walk on a torn ACL? With an acute ACL injury, the patient might experience intense pain after hearing a loud popping sound. The severe pain can make walking painful, and you are unable to put your weight on the injured knee. The knee joint can become swollen after a few hours due to the bleeding within the joint, and you might experience difficulties to straighten your leg.

Can I walk upstairs or downstairs with a torn ACL?

Generally speaking, most of the torn ACL patients can start to climb stairs without using crutches in about one month with a proper physio. If your physio can confirm that your muscle strength has been recovered to a level that permits you to climb around one month after the injury or surgery then the step climbing should not be a big issue. Please do make sure your surgeon or physio has checked that you have regained full quads power and full recovery of stability of your injured knee before attempting.

3. ACL Surgery Recovery timeline

Every patient’s situation can be different when it comes to ACL injuries due to the complexity. ACL surgery recovery times vary widely based on the many factors such as the severity of the injury. The following ACL surgery recovery timeline provides a high-level summary of what to expect after ACL surgery in a rough chronological order before a torn ACL patient can return to form.  You can expect to walk normally without crutches around 4-6 weeks after ACL surgery.

ACL-Surgery-Recovery-Timeline

4. Nonsurgical Options for ACL Tear

Nonsurgical treatment for ACL tear generally involved progressive physical therapy and rehabilitation that can restore the knee to a condition close to before the injury and help patients to learn about how to prevent instability from their knees.

A 2018 study included 300 patients with ACL injuries who did not undergo ACL surgery and 182 who did have indicated that 118 (39.3%) of them have been recovered by remaining nonsurgically treated at 6 months post ACL injury. Hence nonsurgical treatment should be considered as a confident choice, especially for elderly patients with proper knee function early after ACL injury.

Nonsurgical treatment can be supplemented with the use of crutches or ACL knee brace, understand how we can use crutches and ACL knee brace to facilitate nonsurgical treatment is also important for patients who are not going through surgical treatment.

Crutches

walking-with-crutches

Crutches are useful to keep some or all of the patient’s weight away from the injured leg. It can be used depending on physician preference during physical therapy and rehabilitation. During the first few days after the ACL injury, you may experience difficulties in doing weight bearing on your injured leg when walking. Crutches are essential to protect your knee from continued episodes of giving away or buckling. It will typically take around 1-2 weeks or 4-6 weeks for you to regain the strength of your thigh muscles and walk normally depending on the severity of your injury.

ACL knee brace

hinged-knee-brace-for-acl-recovery

Bracing is a personal decision that you should discuss with your doctor to work out what works best for you. The role of a knee brace in an ACL injury as a nonsurgical option is controversial. Knee brace might help you to prevent injury or reinjury. After many researches from top surgeons across the country who are trying to come up with a conclusion for this topic but at the point, it’s still unclear how much of an impact a brace can have in reducing the risk of new or repeat ACL injuries due to the complexity of ACL injuries and the many different ways in which ACL injuries may occur.

The effectiveness of bracing also may depend on factors such as gender, age, the types of sports, the position you play and whether you are comfortable wearing a brace. You can think of your brace as the training wheels you used when you first learn how to ride a bike. A properly fitted ACL brace can become a useful support while you rehabilitate from ACL injury and help limit your need for movements that may increase your risk of reinjury and also help you to regain your full range of motion after the injury. Studies have shown that an ACL brace can help you feel the movement and position of your knee. A concept called proprioception for ACL rehab summarizes those benefits from bracing that may help you feel more confident as you rehab and get back to the activities you love.

Wearing a knee brace to facilitate nonsurgical treatment for ACL is beneficial because it provides stability and limits side-to-side knee movement. A functional ACL knee brace is useful for a person who returns to sport or activity and provide valuable compression to manage swelling. It can also offer a reduction of anterior tibial translation and improved proprioception, which can improve the sense of stability of your knee.

5. Seven Tips for Walking and Recovering with a Torn ACL

ACL-Recovery-tips

If your surgeon allows you to walk after a torn ACL, you should try the following tips for walking and recovering:

  1. Avoid turning, pivoting, or twisting on the knee because it can potentially add damage to your knee cartilage.
  2. For athletes and people with an active lifestyle, you should consult your surgeon to understand if ACL reconstruction is necessary. Please do not try to return to sports just because you don't feel pain anymore, and it doesn't mean your torn ACL has been fully recovered. Do NOT return to sports or activities until you have been treated.
  3. Start walking with 2 crutches before progressing to 1 crutch after ACL surgery, you can try to walk without crutches after 1-2 weeks. This approach can help your repaired leg to adapt to weight-bearing progressively.
  4. After you can walk without crutches, you should try to walk normally by stroking the ground with your heel and make sure you lock your knee up the impact with the ground.
  5. Walking in the swimming pool is a great way to practice walking with full weight-bearing on your repaired leg around 3 weeks after ACL surgery.
  6. Apply ice pack regularly (at least 4 to 5 times a day) can help you to reduce swelling
  7. Ensure you will have adequate rest and sleep and elevation of the knee, especially during the first week after ACL surgery.

6. What Can Be Done to Prevent ACL Injuries?

Educating yourself with proper techniques when playing sports or exercising can be helpful in preventing unnecessary and risky turning or twisting motions. Some sports programs can teach you how to reduce the stress placed on the ACL during sports or daily exercises. Attending a neuromuscular training can also help you to reduce the risk of ACL injuries because it can improve control of dynamic stabilizers and biomechanic movements of your body.

sports-programs-training

Wearing a knee brace can also protect your knee from a sudden change in harmful direction, incorrect jump landing. Knee braces that are specifically made for ACL injuries can also offer enhanced stability, proprioception as well as medical-grade compression which helps you to relieve pain and prevent ACL injuries.

The Takeaway

To sum up, when can you get back to normal walking after ACL surgery? It is a question that every torn ACL patient would like to understand because they are keen to get back to walk, sports or daily activities. In reality, different surgeons put different restrictions on patients, so please do consult your doctor to get the medical advice that is relevant to your situation. The answer can be slightly influenced by your surgeon’s personal preference but also largely influenced by any other related knee problems found during a physical examination or MRI as well as other procedure performed at the same time. Your surgeon might ask you to limit your weight-bearing from 2 - 4 weeks depending on the nature of the ACL tear.

During most of the cases, you are allowed to put weight on your repaired leg soon after ACL surgery, but you may feel discomfort around your knee and require crutches for a few days or in a week or two. Your knee might still be stiff without a full range of motion. Generally speaking, it can take 4-6 weeks for you to regain the strength back for the muscles in your leg before patients can start walking normally after ACL surgery. 4-6 weeks recovery time is generally only referring that you can walk in a straight line.

physio-assisting-a-torn-ACL-patient-Recovery

Your repaired leg may not necessarily feel normal like the uninjured leg, but you should be able to walk without slowing down that much or cause a lot of pain after 4-6 weeks. It will take much longer for you to return to sports. Based on the research study mentioned in this article, 47.5% of patients were able to return to sports activities on an average of 8 months after ACL reconstruction surgery.

Again, this is a general answer for whether you can walk with a torn ACL, there are many factors that will depend on specific situations of each patient. We highly recommend you talk to your doctor to get medical advice that is relevant to your situation. Please also feel free to contact us if you need any help to choose knee braces at PowerRebound for returning to walk or sport after ACL surgery.


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