ACL Rehabilitation

The Anterior Cruciate Ligament (ACL) = major stabilising ligament of the knee. 

ACL tear does not heal and can result in an unstable knee. 

It can be surgically repaired with excellent results – in most cases it will be performed arthroscopically. If wanting to return to sports involving twisting/stepping/change of direction, if you have a physically demanding job or want to maintain an active lifestyle you will have it repaired in most cases. 

Some people can have a good result with conservative management – this will involve completing a good rehab period with a focus on strengthening. 

ACL injuries can occur from stepping, twisting, a blow to the knee/leg (such as a tackle) or by falling awkwardly. 

Physio plays an important role in recovery: Before the operation it will help regain range of motion and strength around the knee. Physio will then commence shortly after the operation to help settle the knee and improve mobility then will guide your rehab right through to returning to sport or normal activities. 

 

ACL REHAB GUIDE

Stage 1 – Recovery

Goals: 

* Reduce pain and swelling. 

* Allow wounds to heal. 

* Regain full extension. 

* Achieve full weight-bearing on affected leg. 

* Wean off crutches and achieve normal gait. 

* Develop muscle activation and control. 

Key Exercises: 

* Passive knee extensions 

* Assisted knee flexion and extension 

* Quadriceps (VMO) activations 

* Calf raises 

* Gentle calf and eventually hamstring stretches 

* Gradually increase weight-bearing until can balance on one leg 

* Gait re-training – heel to toe 

 

Stage 2 – Quads, Loads and Stability

Goals: 

* Achieve full active range of motion. 

* Display normal gait. 

* Muscle control of quads and hamstrings good enough to perform controlled pain-free lunge. 

* Balance unsupported on mini-tramp 30sec+. 

Key Exercises: 

* Active and assisted knee flexion and extension range of motion exercises 

* ¼ squats, static lunges and closed chain step-ups 

* Leg Press 

* Stationary bike 

* Single leg balance progressions 

* Pool exercises can begin once wounds healed, includes treading water, walking in water and gentle swimming (avoid breaststroke) 

 

Stage 3 – Strength

Goals: 

* Perform Single leg bridging with weight by end of stage. 

* Perform drinking bird on mini tramp with good control. 

* Can perform 4 hops in a straight line and complete multi-directional square hops. 

* Commence straight line jogging at end of this stage. 

Key Exercises: 

* Hamstrings = prone HS curl no weight to begin, bridge progressions, drinking bird and straight leg dead-lifts 

* Squats, leg press, exercise bike will be progressively loaded 

* Balance exercises on unstable surfaces 

* Hopping progressions 

 

Stage 4 – Sport Prep

Goals: 

* Continue to build total leg strength – single leg press and single leg bridges comparable to other leg. 

* Progress running – endurance, speed and agility. 

* Complete catch pass and more challenging tasks on mini tramp/uneven surface. 

* Complete sports specific-tasks (ie. Jumping, stepping, pivoting) 

Key Exercises: 

* Running and gym programs will include sport-specific exercises 

* Change of direction exercises to develop control and confidence 

* Loads will continue to increase with strengthening exercises 

 

Stage 5 – Return to Sport and an Active Lifestyle

Goals: 

* A successful return to sport and normal activity levels. 

Requirements: 

* Complete 1 month of full training prior to an active return to competitive sport 

* Return to contact progressions for contact sports 

* Functional testing scores within 95% of other leg 

* No effusion with increased training loads