Cruciate ligament injuries: Symptoms, diagnosis and treatment

The Anterior Cruciate Ligament (ACL) and the Posterior Cruciate Ligament (PCL) are the main stabilisers of the knee joint. Both are structures that are frequently injured during sports such as netball, skiing, basketball and football.

Cruciate ligament injuries occur when the knee is twisted due to a person landing awkwardly or changing direction rapidly. PCL injuries may also occur when a significant force is applied to the front of a bent knee, for example in a rugby tackle or a road accident.

ACL injuries are of particular concern as they frequently cause damage to surrounding structures like the PCL, collateral ligaments and meniscus.


There are a number of signs that a patient has sustained a cruciate ligament injury which healthcare practitioners should be aware of. Main ones include:

  • Severe pain and inability to continue an activity
  • A loud “pop” or a “popping” sensation in the knee
  • A feeling of instability or “giving way” with weight bearing
  • Loss of range of motion
  • Rapid swelling


The patient’s knee should be checked thoroughly for swelling and tenderness. You should also move the knee into a variety of positions to assess the range of motion and overall function of the joint.

Often a physical exam alone is enough to diagnose a cruciate ligament injury. However, the patient may need tests to rule out other causes and to determine the severity of the injury. These tests may include X-rays, an MRI or an ultrasound.


Many cruciate ligament injuries will heal on their own but some will need surgical repair. Although technically it is possible to function without an ACL, the joint will be very unstable and often painful. Some patients find that by strengthening the hamstring muscles and quadriceps they can achieve enough stability through muscle strength, but for athletes this won’t be sufficient.

ACLs that are repaired surgically usually require knee reconstruction. This involves either the hamstring tendon or patella tendon being used to fashion a ‘new’ ACL. After the surgery is performed, the knee will need to be assessed six to eight weeks later to determine how well it’s healing and whether any further surgery is needed.

Effective rehabilitation after an ACL reconstruction is essential. It should be focussed on range of movement, swelling management, strengthening, balance training and proprioception. Whilst all cases are different, patients can expect to be able to start running again around four months after their surgery. Higher level skills such as weaving and jumping may be not be possible until around the six to twelve month mark.

Identifying a cruciate ligament injury and providing the right treatment is key

Designed specifically for nurses, junior doctors and other allied health professionals, PDUK provides a couple of very popular courses that cover knee pain and injury. Both are being offered online, making them an easily accessible option for individuals looking to gain additional CPD hours from home. 

The Minor injury essentials online course is aimed at practitioners whose clinical remit includes assessing and managing basic injuries. On completion, participants will have gained confidence in dealing with these presentations and have a solid foundation to build upon. It’s a 3-day course worth 21 hours of CPD. Start dates are the 3rd March and the 22nd June 2021.

The second course is Refresh and refine knee assessment techniques and management skills. Like our Minor injury essentials course, it’s a highly interactive, flexible programme for those who regularly assess knee injuries and ailments in acute settings. It’s a half-day course worth 4 hours of CPD, and is due to be held online on the 1st March 2021. All our courses are popular so secure your place early to avoid disappointment.