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What it is
The Anterior Cruciate Ligament (ACL) is one of the primary ligaments that help to stabilise the knee. The role of the ACL is to prevent the shin bone (tibia) from moving excessively forward in relation to the thigh bone (femur) and to limit rotational movement of the knee. ACL injuries can be either non-contact injuries e.g. pivoting/twisting, sudden deceleration, landing from jump, or contact injuries e.g. blow from another player.
Symptoms of an ACL injury
Patient-reported symptoms that raise our suspicions of an ACL injury typically include:
- Feeling or hearing a ‘pop’ at the time of injury
- A sudden feeling of instability in the knee
- Immediate swelling and limited knee movement
- Pain on the outside and/or back of the knee
Knee swelling that occurs suddenly is often a sign of a serious knee injury and should be assessed by a physiotherapist and/or sports doctor.
Getting the right diagnosis
Following a suspected ACL injury, the RICE method (rest, ice, compression and elevation) is an appropriate first step. We then recommend an assessment with a sports physiotherapist or sports doctor to determine the nature of the injury and whether further investigations e.g. MRI scan are needed. If an ACL injury is confirmed, further assessment with an orthopaedic surgeon may follow to determine whether surgical or conservative management is appropriate.
Where surgery is chosen (an ACL reconstruction), the physiotherapist and surgeon liaise to guide a rehabilitation program suited to the specific procedure. A typical rehabilitation program progresses through the following stages.
A typical rehabilitation timeline
Review soon after surgery to guide correct range-of-movement exercises. Swelling management with ice and compression, a focus on establishing a good walking pattern, muscle-control exercises and avoiding strain on the knee.
Regain full range of motion and commence recommended strength, balance and proprioception exercises. Hydrotherapy and a stationary bike can usually be started with care.
Progress hamstring and quadriceps strength, stationary-bike intensity and single-leg weight-bearing exercises. Still no running, twisting, hopping or impact activities.
Commence running in straight lines, with additional leg strengthening and higher-level proprioception exercises.
Continued progression with sport-related activities, running intensity and direction changes. A return to sporting activities and competition is usually worked towards around 12 months.
Related service: Sports Physiotherapy →
Frequently asked questions
Do all ACL injuries need surgery?
Not always. After assessment — and any investigations such as an MRI — an orthopaedic surgeon can help determine whether surgery is required. Some people are managed without surgery, depending on the individual, their goals and their activities.
What should I do straight after the injury?
The RICE approach — rest, ice, compression and elevation — is a sensible first step, followed by an assessment with a sports physiotherapist or sports doctor to determine the nature of the injury.
When can I return to sport after an ACL reconstruction?
Rehabilitation is progressive and guided by your milestones. Following surgery, a return to sport and competition is typically worked towards over roughly 12 months, in coordination with your surgeon.