An anterior cruciate ligament (ACL) injury is one of the best-known knee injuries in sport, common in football, netball, basketball, skiing and any sport with pivoting and landing. It’s a significant injury, and the early weeks matter, but there’s a clear, well-researched path through it, whether you end up having surgery or not.
Understanding ACL injuries
The ACL is one of the main ligaments inside the knee, preventing the shin from sliding forward and helping control rotation. Most tears happen without contact, during a sudden change of direction, landing or deceleration. Because the ACL can’t be felt directly, diagnosis comes from your story, a clinical examination and, if appropriate, MRI.
Other structures are often injured at the same time, including the meniscus, cartilage and other ligaments, which affects the treatment plan. That’s one reason a careful assessment early on is worthwhile.
Symptoms we commonly see
- A pop or tearing sensation at the time of injury, and immediate difficulty continuing
- Swelling in the knee within hours
- A feeling of instability, buckling or the knee giving way
- Reduced knee movement, especially straightening fully
- Pain, particularly with walking, twisting and pivoting
- Loss of confidence in the knee
Our evidence-based approach
Evidence-based recommendations describe three main pathways for ACL rupture: rehabilitation as first-line treatment, reconstruction with post-operative rehab, or pre-operative rehab followed by reconstruction and post-operative rehab. The right one depends on your age, activity goals, how the knee behaves and other injuries. Our approach includes:
- Early assessment, to understand which structures are involved and to rule out fractures and other injuries that need urgent care
- Prehab, to settle swelling, regain full movement and restore quadriceps activation before any surgery
- Balanced information on surgical and non-surgical options, so the decision is yours, made with the best evidence
- Criteria-based rehabilitation, whether you have surgery or not, progressing strength, control, running, hopping and landing in clear phases
- VALD performance testing of strength and hop performance at key stages, so decisions are based on data
- Return-to-sport criteria, rather than a date, to reduce the risk of reinjury
- Ongoing strength and injury prevention work in our private gym, once you’re back
Our ACL rehabilitation service page sets out the program in detail, and our post-surgery recovery page covers rehab after other operations.
What to expect: recovery timeline
- First few weeks: reduce swelling, regain full movement and restore quad control, whether or not you’re heading to surgery
- After reconstruction: a structured program through the following months, with return to sport most often around nine to twelve months
- Non-operative pathway: commonly a structured strengthening and control program over a few months, with a decision about surgery if the knee keeps giving way
When to seek help urgently
Seek prompt assessment if you can’t put weight through the leg after an injury, your knee is locked or won’t straighten, has swollen significantly, or you have numbness, a cold or pale foot or severe pain. After surgery, call your surgeon or go to a doctor for fever, a hot, red, swollen calf or wound, or sudden shortness of breath.
References
- Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33-47.
- Frobell RB, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232.
- Beard DJ, et al. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial. Lancet. 2022;400(10352):605-615.
- Diermeier T, et al. Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group. Knee Surg Sports Traumatol Arthrosc. 2020;28(8):2390-2402.
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808.