Anterior Cruciate Ligament (ACL) Injury

First and foremost, R.I.C.E.

Rest

The first thing you need to do after an ACL injury is to stop moving the affected leg. Rest is essential to prevent further damage to the ligament and surrounding tissues. Avoid adding weight onto the injured knee, as this could worsen the injury. Find a comfortable position to keep the knee still and relaxed, ideally keeping it elevated. The goal is to protect the knee and avoid any unnecessary movement that could hinder the healing process.

Ice

Applying ice as soon as possible can help manage pain and swelling. Ice works by numbing the area and constricting blood vessels, which reduces inflammation and helps prevent excessive swelling. Wrap some ice or an ice pack in a cloth and apply it to the knee for 15–20 minutes every 1–2 hours during the first 48 hours. Just be sure not to use the ice directly on your skin to avoid frostbite. Ice should be a key part of your treatment during the initial recovery phase.

Compression

A compression bandage can help reduce swelling and support the injured knee. Gently wrap an elastic bandage or compression around the knee, but avoid tightening it. You want to provide light pressure without cutting off circulation. If you notice increased pain or numbness, loosen the bandage immediately. Compression helps maintain stability while also preventing excess fluid buildup around the joint.

Elevation

Elevating the injured leg is one of the most effective ways to reduce swelling. Position your leg so that your knee is raised above the level of your heart. This helps drain fluid from the knee, making it easier for your body to manage inflammation. Use pillows or cushions to support your leg while resting or sleeping. Try to elevate your knee as much as possible during the first few days after the injury to minimise swelling and promote faster healing.

Seek Medical Attention

Even if you think the injury is minor, it’s always best to seek medical attention immediately. Its injuries can range from mild to severe, and only a healthcare professional can adequately assess the damage. They may recommend an X-ray or MRI to confirm whether the ligament is torn or sprained. In some cases, surgery might be required to repair a torn ACL, but this will be determined based on the severity of the injury.

Pain Relief and Ibuprofen

Pain and swelling are a big part of recovering from an ACL injury. One of the most effective ways to manage both is with pain relief medication, and ibuprofen is a great option to consider. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces inflammation in the body. This is particularly helpful for ACL injuries because it targets the pain and swelling often accompanying ligament damage.

Inflammation is one of the body’s natural responses when you injure your ACL, but it can lead to increased body stiffness, making it harder to move and heal. By taking ibuprofen, you can help reduce the swelling around the knee, which will relieve pain and make it easier for you to rest, ice, elevate, and compress the area without as much discomfort. If you can't take ibuprofen, paracetamol or co-codamol will suffice. This is the strongest over-the-counter pain relief.

For most people, ibuprofen can be safely taken as directed to manage pain, but it’s essential to follow the recommended dosage to avoid sides. Typically, you can take ibuprofen every 4-6 hours but don’t exceed the daily maximum recommended dose. It is not best taken with food or after meals to reduce the risk of stomach irritation, a common side effect of NSAIDs.

While ibuprofen can effectively manage mild to moderate pain and swelling, it’s important to remember it's a solution. If your pain or swelling doesn't improve you should contact your emergency department for further advice.

Heat should be avoided in the early stages of recovery as it can increase swelling. Also, don’t attempt to walk on the injured leg or resume phydon't activity until a medical professional has cleared you. Trying to push through the pain might delay healing and cause long-term damage to the knee.

The first few hours after an ACL injury are critical for minimising damage and setting yourself up for a smoother recovery process. Proper rest, ice, elevation, and compression will help reduce swelling and prepare you for the next steps in treatment.

For pain relief relating to an ACL injury, a sensible stepwise approach is to take one or two paracetamol tablets up to four times daily (ideally leaving a 4 to 6 hour interval between doses). Paracetamol is generally well-tolerated and safe for most (unless for example, you have a severe liver problem).

Ibuprofen is known to cause irritation to the stomach lining, so it's best to take ibuprofen with food. You should speak to your doctor or pharmacist before taking ibuprofen if you are taking any other medicines, particularly blood pressure or stroke prevention medicines, if you have kidney disease, if you are pregnant, or if you have previously had a gastric ulcer.

Additional pain relievers are available over-the-counter which are codeine-containing combinations with either paracetamol (co-codamol), or ibuprofen – these may relieve more severe pain.

Knee supports with braces can help to provide stability around the knee joint, as well as mild compression and warmth to the joint. These may be helpful to prevent further injury caused by unstable rotation or weight-bearing movement of the knee joint.

If in doubt about any medicines or appliances, or the suitability for you specifically, please speak to your local pharmacist, sports therapist, or doctor.

You should get an urgent doctor's appointment, call NHS 111 or go to an urgent care centre if you think you have injured your ACL.

The doctor will ask about what happened and your symptoms and will examine your knee. They may send you for an X-ray or MRI (or both). Anterior cruciate ligament injuries can often occur alongside other damage to your knee, so this is why an X-ray or MRI can be useful.

Treatment for an ACL injury can be divided into two categories of either non-surgical treatments or surgery. Which is recommended depends on the severity of the injury and an individual's activity levels prior to injury.

Non-surgical options include wearing a knee brace and off-loading the knee by using crutches to allow healing. This will entail directed physio to help strengthen the supporting structures of the knee. This is appropriate in very mild (Grade 1) ligament injuries or in people not needing to be very active.

Surgery involves reconstructing the ligament. This ultimately provides the most support for the knee, so is appropriate if someone wants to get back to a high level of exercise or sport, even with Grade 2. It is usually required in a complete tear of the ACL (Grade 3).

Your doctor will assess whether you are fit for work depending on the nature of your job. You may be able to return to work with altered duties.