ACL injury: rehabilitation, with or without surgery

The anterior cruciate ligament (ACL) is one of the main ligaments that keep the knee stable when you twist, turn or land from a jump. ACL tears are common in sports like football, cricket, kabaddi, basketball and badminton, often from a sudden change of direction or an awkward landing. Whether or not you have surgery, structured rehabilitation is what decides how well your knee works afterwards.

Signs of an ACL injury

• a pop or snap felt or heard at the time of injury

• swelling within a few hours

• difficulty carrying on with the sport

• the knee feeling unstable, or giving way, especially when turning

See a doctor for an assessment. A clinical examination, and sometimes an MRI scan, confirms the injury and checks for damage to other parts of the knee.

Surgery or not?

There are two main paths:

• Rehabilitation alone, which suits some people, especially if they do not plan to return to sports with a lot of twisting and pivoting.

• ACL reconstruction surgery, followed by rehabilitation, which is often recommended for people returning to such sports or whose knee keeps giving way.

This is a decision to make with an orthopaedic surgeon. Either way, physiotherapy is central.

Before surgery: prehab

If you are having surgery, physiotherapy beforehand helps:

• reduce swelling

• regain full straightening and good bending

• rebuild strength in the thigh muscles

• walk normally

People who go into surgery with a calm, mobile, strong knee usually recover faster afterwards.

Rehabilitation phases

Programmes vary with the surgeon and the person, but rehabilitation commonly moves through these stages:

1. Early phase: control pain and swelling, regain full straightening, start bending, activate the thigh muscles, walk normally.

2. Strength phase: progressive strengthening of the thigh, hip and calf; balance and control exercises; cycling.

3. Running and agility: a gradual return to running, then changes of direction, hopping and landing practice, once strength and control allow.

4. Return to sport: sport-specific drills, then training, then matches, only after passing strength and movement tests.

Progress is based on meeting goals at each stage, not only on time passed.

Returning to sport safely

After reconstruction, return to sports involving pivoting is commonly around nine months or more. Going back too early, before strength and control have returned, increases the risk of injuring the same or the other knee. Your physiotherapist can test your strength and hopping on both legs and compare them.

Preventing ACL injuries

Programmes that train how you land, cut and change direction, along with strength and balance work, can reduce the risk of ACL injury, particularly in young athletes. Ask a physiotherapist about warm-up programmes for your team.

When to get urgent help

After an injury, see a doctor promptly if you cannot put any weight on the leg, the knee looks deformed, or your foot becomes numb, cold or pale.

Find a sports physiotherapist

Search for physiotherapists who treat sports injuries on PhysioDesk Reach, see their services and reviews, and contact them directly.

This article is general information, not medical advice. Follow the advice of your surgeon and treating team.