Grading Your ACL Tear

A tear to your ACL is always concerning, but some cases are more serious than others. Read on to learn how your injury is graded or classified and what you can expect with treatment and prognosis.

An ACL tear involves the anterior cruciate ligament, a major stabilizing structure of your knee. This ligament connects your thighbone to your shinbone and helps stabilize your knee joint.

Injury to the ACL occurs most often when you stop suddenly or change direction. The ACL is also vulnerable if you land awkwardly from a jump. Skiers, soccer players, basketball players, and football players are especially vulnerable, but really anyone can experience an ACL tear due to a work injury or car accident.

At the time of the injury, you’ll probably hear a pop or feel a snap in your knee joint. You’ll notice pain, which can be quite severe. Usually, an ACL injury stops you from activity right away, and you develop swelling at the knee joint.

When you come to Maryland Orthopedic Specialists with a suspected ACL tear, our medical team evaluates your symptoms, examines the knee joint, and orders imaging exams like X-rays and an MRI.

ACL tear classifications

We also classify the injury as grade 1, 2, or 3. Here’s what those classifications mean for the extent of your injury and your recovery.

Grade 1 ACL tear

A grade 1 tear is the mildest case of the injury. You have microscopic tears that stretch the ligament, but the ligament can still provide support to the knee joint.

Grade 2 ACL tear

Grade 2 tears are rare. In this case, the ACL is stretched and partially torn. You notice some instability in the knee joint so that it collapses periodically when you stand or walk.

Grade 3 ACL tear

A grade 3 ACL tear is the most severe case. The ligament is entirely torn so it can’t provide stability to the knee joint. Your knee feels very unstable. The majority of ACL injuries are grade 3 tears.

Tibial spine avulsion ACL injury

This type of ACL injury occurs in teens. The ACL hasn’t torn, but the attachment of the ligament to the tibia has pulled off partially or entirely.

Treatments for ACL tears

Conservative treatments for grade 1 and 2 tears include RICE (rest, ice, compression, and elevation). We may have you wear a knee brace and manage pain with nonsteroidal anti-inflammatory drugs (NSAIDs).

We also put you on a rehabilitation program once the initial pain and swelling subsides. This physical therapy strengthens the muscles around your knee to help stabilize the joint and prevent future injury.

If you have a grade 3 tear, you may recover fully using these conservative treatments, especially if you plan to live a sedentary lifestyle or one with just mild activity like biking and jogging. But in some cases, level 3 tears may require surgical repair. 

Your treatment plan really depends on your recovery goals. If you want to get back to an active lifestyle that involves running, pivoting, and jumping, we may recommend surgery over pain management and physical therapy alone.


The vast majority of patients with an ACL tear recovery fully as long as they follow their rehabilitation plan. But people who suffer a grade 3 tear are prone to developing osteoarthritis in the injured knee joint later in life. 

If you have suffered any type of knee injury, contact our Bethesda or Germantown, Maryland, office for diagnosis and long-term treatment or book using our online system. We want to help you get back a high quality of life and sports play.

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