Tearing your anterior cruciate ligament – regularly abbreviated to ACL – is one of the worst sporting injuries you can endure.
Trust me, I know.
I tore my left ACL in 2011 playing football, and one reconstruction and two arthroscopies later (to clean out scar tissue) there are definitely days where I can feel that my knee has been surgically repaired.
But, I’m certainly not alone as while it’s a serious injury, it’s also extremely common – between 100,000 and 200,000 people tear their ACLs in the United States alone, with that number far greater worldwide.
Once an ACL is torn, or ruptured, it cannot heal on its own due to poor blood supply and the best course of action is to have it surgically reconstructed using a piece of your own tissue (most commonly either your hamstring or patella tendon).
But the big question, especially for golfers who have suffered this injury but have yet to get it fixed, is: can you play golf without an ACL?
The ACL is the key stabilising ligament in your knee, and without it the joint becomes unstable and, as a result, susceptible to further injury – especially when placing big rotary loads through the knee such as during the golf swing. You can play golf without an ACL, but you risk doing more damage to the surface cartilage, or meniscuses, found within the joint.
As someone who has experienced life with and without an ACL, I would – from own my personal experiences – highly advise against playing golf if you’ve torn your ACL and haven’t undergone surgery to reconstruct it.
In the weeks after my injury, my knee became very unstable and would sometimes buckle at the slightest change of direction – or simply when walking – and I couldn’t have imagined swinging a golf club without an ACL.
If you are desperate to get back out on the course quickly, one way to potentially do so is by wearing a knee brace (such as the MODVEL Knee Brace, which you can buy from Amazon) as this may give you some added support – however, this does come with risks.
If you further damage your knee before your surgery, it may impact how well you recover after your operation and even possibly lead to early-onset arthritis later in life – and, personally, I don’t think there’s any point risking the long-term health of your joint over a few rounds of golf.
Since I’ve had my ACL reconstructed, I play golf regularly – up to three times a week – without any issue at all, and my knee feels rock solid and extremely stable (I can still give driver a rip and have plenty of clubhead speed).
There are a few forums online where some amateur golfers say they’ve played golf with a torn ACL, but I would certainly advise against this based on my own experience.
If you’re unsure what to do, consult with a medical professional (either your doctor or surgeon) and they will clearly explain the risks to you about playing golf with a torn ACL and whether or not it is advisable to do so.
Table of contents
What is an ACL/how is it injured?
The anterior cruciate ligament (ACL) is one of four ligaments found in your knee, and is the most important in keeping your knee stable by preventing your tibia (shin bone) from moving too far forward on your femur (thigh bone), or rotating too much.
The other three ligaments – the posterior cruciate ligament (PCL), lateral collateral ligament (LCL) and medial collateral ligament (MCL) – also assist joint stability, but nowhere near to the level of the ACL.
This is why the ACL is the easiest ligament in the knee to injure, due to its significant role in keeping the knee stable.
The ACL is commonly injured in two ways: with or without contact to the knee joint, and I’ll explain both below.
Without contact
This is by the far the most common way the ACL is ruptured and usually occurs in high-paced sports that require dynamic or sudden stop-start changes of directions at speed – such as football, basketball or soccer.
It’s highly uncommon for golfers to tear their ACLs during a round.
An athlete can tear their ACL by planting their foot before attempting to change direction – the shearing motion within the knee joint, caused by the tibia rotating one way and the femur another way, may lead to the ligament rupturing.
The same action can occur when landing from a jump, causing the knee to buckle.
You will often hear a ‘pop’ and feel immediate pain when the ACL ruptures.
With contact
This is the less common way to tear your ACL and occurs when another athlete falls across your leg – either from the side, or from the front – forcing the knee joint into an unnatural position and causing the ligament to rupture under the excess load.
This is more likely to occur during contact sports, and is the way that I tore my ACL all those years ago.
When a contact ACL injury occurs, it’s highly likely that other parts of the knee joint will be damaged in the process – most commonly the MCL and the meniscus (which is a piece of cartilage that acts as a shock absorber in the knee).
An injury to the ACL, MCL and meniscus at the same time is referred to as the ‘Unhappy Triad’ by orthopaedic surgeons.
How does a torn ACL affect your golf swing?
Arguably the most important way to generate power and consistency in your golf swing is through the use of your legs, and being able to rotate effectively.
Having a torn ACL in either your lead or trail knee may affect your golf swing in the following ways:
Lead leg
Your lead leg absorbs the most force during the golf swing, and also rotates the most – especially as you turn through from the backswing, into impact and then ‘posting up’ on your leg in that classical finishing position.
If you have a torn ACL in your lead knee, this may hinder your ability to make a full turn during your backswing.
You may also be reluctant to shift your weight back onto your lead side during the downswing and finish with a straight lead leg for fear it could buckle due to instability created in the absence of a fully-functioning ACL.
As a result, you will likely lose both power (and subsequently distance) and consistency in your swing.
Trail leg
During the backswing, a significant load is placed through your trail leg as your weight transfers to your trail side.
Similarly, your trail leg is extremely important during the downswing in order to begin shifting your weight back to your lead side – often by ‘pushing off’ your trail leg.
A torn ACL in your trail leg, and the instability it can cause, may result in you being unable to load effectively in your trail side during the backswing, or push off during the downswing.
Both can also see a loss of power and consistency in the swing.
Should I play golf with a torn ACL?
There is a big difference between whether you can or should play golf with a torn ACL.
Yes, you can play golf with a torn ACL, but that doesn’t mean you should.
From my own personal experiences, I would not recommend playing golf with a torn ACL for the following reasons:
- The lack of an ACL will make your knee far more unstable and susceptible to further injury due to the severe rotational forces the golf swing places through your knees (especially your lead knee)
- Further damage to the knee can make your eventual reconstructive surgery more complicated, and possibly affect your recovery post-operation
- Further damage to the knee, such as to your surface cartilage or meniscuses, has been proven to attribute to early-onset arthritis
- It will likely cause you pain, making your round far from enjoyable
- You will subconsciously begin to ‘guard’ your injured knee when you swing and develop bad habits over time that will have a negative effect your game
How do you fix a torn ACL?
Due to a lack of blood supply to the ligament, once the ACL is torn it cannot heal on its own – the only way to resolve instability is to perform knee reconstructive surgery.
During this procedure, which is performed under general anaesthetic, a trained orthopaedic surgeon will drill into the knee (sounds gruesome, I know) and fix a graft in place between the tibia and femur that over the next 9-12 months will mature into a new ACL.
There are four choices of graft that can be used – hamstring, patella tendon, quadriceps tendon and allograft. Each are outlined below in greater detail.
Hamstring graft
The hamstring graft is becoming increasingly used for amateur athletes due to its low donor site morbidity, strength, ease of fixation within the knee, and lower incidence of early onset arthritis.
It’s a great option for people who kneel a lot at work (as the graft isn’t taken from the front of the knee, like the patella tendon graft, and will less likely lead to anterior knee pain).
During the reconstruction, the surgeon will use a stripper tool to remove your semitendinosus and gracilis tendons, which will then be stitched together and used as the graft.
This is the graft I used for my knee reconstruction.
Patella tendon
Long considered the ‘gold standard’, this graft option involves removing the middle third of your patella tendon along with bone plugs from your kneecap and tibia.
This graft is extremely strong and the bone-to-bone fixation means you can typically start more strenuous rehabilitation exercises earlier than other graft options.
The main downside is that removing the middle third of the patella tendon can lead to anterior knee pain, and in some cases an increased chance of early onset arthritis.
Quadriceps tendon
This is a newer method being adopted by some surgeons as an alternative to the hamstring or patella tendon options.
It involves the surgeon removing the middle third of your quadriceps tendon, and also a bone plug from the top of your knee cap.
The benefits of this graft is the decreased chances of anterior knee pain (due to avoiding using the patella tendon) and less likelihood of post-surgery hamstring weakness (by avoiding using the hamstring tendons).
While it is less commonly used, the quadriceps tendon graft is becoming a more accepted option for ACL reconstruction.
Allograft
This involves using the patella tendon, hamstring tendon or quadriceps tendon of a deceased person.
The benefits of using an allograft is there is no harvest site morbidity (as the surgeon isn’t using the patient’s own tissue), meaning less pain and often faster rehabilitation.
The major downside of the allograft is studies have shown it to be far weaker than the patella tendon, hamstring or quadriceps tendon graft, leading to higher chances of re-rupturing the graft.
Which ACL graft is better for golfers?
When factoring in anterior knee pain post-surgery, donor site morbidity, ligament strength and ease of fixation, I would say the hamstring graft would be the best graft for golfers to use.
However, this is only speaking from my personal experiences – you should talk with your doctor or surgeon to decide which graft is best for you.
For reference, Tigers Woods used a hamstring graft when he had his left knee reconstructed in 2008.
If it works for arguably the greatest golfer of all time, it can certainly work for the weekend warrior.
How quickly can I play golf after ACL surgery?
The medical advice varies, but most online resources suggest you can return to playing golf around four months post-surgery if you used a patella tendon graft, or six months if you used a hamstring graft.
The earlier return time for the patella tendon graft is likely due to the stronger bone-on-bone fixation, whereas the hamstring graft takes longer to fuse itself within the knee.
But, as is always recommended, you should speak to your doctor or surgeon and get the ‘all clear’ before teeing it up on the golf course again.
The last thing you want is to re-rupture the ACL graft and be required to have the procedure again.
Disclaimer: I do not claim to be a medical professional for I am not one. Everything in this blog post is based on my own research and personal experiences. You should seek medical advice for anything related to torn ACLs or playing golf with a torn ACL.