ACL Rehabilitation. What is it?

The anterior cruciate ligament (ACL) is a structure that helps the stability of the knee joint. It connects from the thigh bone (femur) to the shin bone (tibia).

This ligament can rupture during deceleration, sports contact, improper landing, changing direction, or from the knee collapsing inward. There is usually a ‘pop’ sound with immediate swelling and a feeling of instability. If the ACL has been ruptured the medial collateral ligament (MCL) and medial meniscus may also be damaged.

How long does it take to get better?

The ACL can be repaired with surgery OR it can be managed without surgery. This depends on several factors ( It is important to discuss with your physiotherapist and healthcare providers the option that would best suit you.

If you are going to undergo ACL surgery, a pre-surgical therapy program should be undertaken first. Delaying surgery by 5 weeks and completing an intensive exercise program before surgery resulted in better outcomes 5 years after ACL surgery (Filbay et al 2017).

After surgery, 9 months is the minimum time frame for the tissue to heal as well as allow enough time to complete return to sports rehabilitation (Beischer S et al 2020). The time to get back to walking and other activities is earlier than this, but a comprehensive rehabilitation program needs to be in place before going back to contact sports that require cutting, changing directions, and landing.

Here is a useful guide to give an outline of the rehabilitation process:

Melbourne ACL Rehabilitation Guide 2.0

 Preoperatively the goals will be:

  • Reduce swelling, regain range of motion, regain 90% strength in the quads and hamstring compared to the other side, single-leg hop 90% compared to the other side

 Phase 1: Recovery from surgery

  • 1-2 weeks
  • Get the knee straight
  • Reduce swelling with ice and compression
  • Activating the quadriceps

Phase 2: Strength, balance, and control

  • Begins with bodyweight exercises and progresses into gym-based
  • Regain single-leg balance
  • Regain muscle strength
  • Single-leg squat control

 Phase 3: Running, agility, landings

  • Improve hopping
  • Improve agility
  • Full strength and balance

 Phase 4: Return to sport

  • An athlete is comfortable, confident, and eager to return to sport
  • ACL injury prevention program
  • Score a 95+ on Melbourne’s return to sport score

 Phase 5: Prevention

  • Includes plyometric, balance, and strength exercises
  • Performed more than once per week for at least 6 weeks
  • Popular programs include:
    •  Sportsmetrics program
    • The FIFA 11+ warm-up
    • The PEP program
    • The KNEE program – netball Australia
    • The footy first program – AFL

Progression in each of these phases depends on how quickly you respond to each of the exercises.