What Grade of ACL Tear Do I Have?

You've injured your knee and determined that it is likely an ACL injury given the location of pain and activity that caused it, but how bad is it?

ACL tears are unfortunately growing more common in athletes and active people in general. According to the Panorama Orthopedic & Spine Center, "each year in the U.S., about 400,000 ACL reconstruction surgeries are performed to address these injuries." Vincent Minjares, Ph.D., stated in an article from 2023 that "The National ACL Injury Coalition reviewed injury data for 12 major girls and boys sports over five three-year periods from 2007 to 2022, as supplied by certified athletic trainers in the High School RIO surveillance program. From period one to five, the average annual ACL injury rate grew 25.9% to 7.3 injuries per 100,000 athlete exposures." With this in mind, we want to make sure you're educated on the different types of ACL tears so that you will feel better equipped to deal with the issue.

ACL tears are divided into three different grades: 1, 2, and 3. Grade 1 is the lowest on the severity scale. These are typically a milder case of microtears to the ligament fibers of the cruciate. This is caused by the ligament being pushed slightly past its safe limit, causing minor damage from overstretching. While still uncomfortable, the knee will still be able to maintain its basic function. Per the Sports Orthopedic Institute, the symptoms from this grade can range from mild pain, slight swelling, mild stiffness/tenderness, and minimal functional limitation.

Treatment for a grade 1 tear is fairly standard. The RICE method can be used to help any pain and swelling. Activities which aggravate the knee should be avoided until initial symptoms have retreated enough to begin gradual rehabilitation exercises.

A grade 2 tear of the ACL is a more serious damaging of the cruciate. According to the Sports Orthopedic Institute, and the Bone & Joint Clinic of Baton Rouge, a grade 2 involves partial disruption of ligament fibers, typically affecting 20-80% of the ligament structure. This represents a more significant injury where some fibers remain intact while others are completely torn. The symptoms will also be noticeably more debilitating. "Patients will experience greater levels of pain and more obvious symptoms, including swelling, bruising, and knee instability."

A grade 2 will usually require a longer recovery period than a grade 1. Symptoms will include significant swelling/bruising, moderate pain when bearing weight on the knee, and a feeling of instability in the effected knee. Dependent on the level of damage, a grade 2 may even require surgical repair. The potential procedure would be determined between the patient and an orthopedic specialist.

A grade 3 tear of the ACL is a complete rupture of the ligament entirely. "All fibers are torn and the ligament loses its structural integrity and function entirely." This is the most severe grade an ACL can be given. Around 70-80% of those who have suffered a grade 3 ACL tear report hearing an audible pop when the tear occurs. Immediate symptoms are significant pain in the area, loss of function in the knee, significant swelling occurring within an hour of injury, and complete inability to bear weight. In the event of a grade 3 tear, an examination with a specialist should be sought out as soon as possible to determine the extent of damage and a plan for recovery.

It's worth noting that according to the Clinic of Baton Rouge, "Surgical repair of a Grade 3 tear is likely although not always necessary. If a patient lives a largely sedentary life with only mild physical activity, a complete recovery may be achieved using conservative treatment methods including several weeks of intensive orthopedic physical therapy. If surgery is chosen, full recovery and return to normal activity will take several months." 

An ACL injury of any grade is something to be taken seriously as the knee is in almost constant use and can be easy to exacerbate damage, even accidentally. Paying close attention to your symptoms and making sure to treat it with proper care and attention can save you recovery time and significant discomfort. Keep an eye on how it feels, and don't be afraid to seek a medical professional's opinion if you don't notice improvement.