What Are the Different Levels of an ACL Tear?

There are 250,000 anterior cruciate ligament ruptures in the United States every year¹. The anterior cruciate ligament (ACL) is one of four major stabilizing ligaments of the knee. The ACL, along with the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), play crucial roles in helping the knee function normally. When one or more of these ligaments is injured, daily activities such as going up and down stairs or walking across uneven terrain can become more challenging. Similarly, an injury to one or more knee ligament(s) can make running, cutting, or jumping difficult in sports. Not all ACL injuries are created equal, as some are more severe than others. Let’s take a look at how ACL injuries are classified.

ACL Classification

The basic classification system for ACL injury follows a three-class grading system. Injuries are graded based on severity: Grade 1, Grade 2, and Grade 3. Grade 1 injuries are the least severe, and Grade 3 injuries are the most severe. All three grades are varying levels of a sprain of the ACL. Sprains refer to ligament injuries, whereas strains refer to muscle injuries.

• Grade 1 injuries involve the partial overstretch of the ACL. This means the ligament is still structurally intact
• Grade 2 injuries involve partial tearing of the ACL
• Grade 3 injuries are complete tears

Management of ACL injuries can vary based on severity and the treating healthcare provider. Generally speaking, Grade 1 injuries are managed without surgery, Grade 2 injuries can be managed with or without surgery, and Grade 3 injuries with surgery. There are exceptions, but this is what is often observed. The non-surgical intervention uses physical therapy to address pain, mobility, and strength, whereas surgery serves to reconstruct the ACL, which is then followed by physical therapy.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

References:
1. Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47. doi: 10.1016/j.berh.2019.01.018. Epub 2019 Feb 21. PMID: 31431274; PMCID: PMC6723618.