THE TRUTH ABOUT ACL TEARS: REHAB, RECOVERY AND RETURN TO SPORT
WHAT IS THE ANTERIOR CRUCIATE LIGAMENT (ACL)?
The ACL is one of the four major ligaments of the knee and is important for stability.
Think of the ACL like a seat belt for your knee. It prevents your shin bone (tibia) from sliding too far forward, rotating and keeps the joint stable during quick movements like pivoting and landing from a jump.
When the ACL is torn or ruptured, the knee often feels unstable like it could “give way” at any moment.
COMMON CAUSES OF ACL TEARS
ACL injuries are very common in sports that involve sudden stops, changes of direction or jumping.
In Australia, the most common culprits:
- Netball: sudden pivots and landings
- AFL & soccer: twisting tackles, quick direction changes
- Basketball: landing from rebounds
- Skiing: awkward falls and landings
Interestingly, women are 2-4 times more likely to injure their ACL due to differences in biomechanics, hip and knee alignment and muscle mass.
SIGNS & SYMPTOMS OF AN ACL INJURY
- A “pop” or tearing sensation at the time of injury
- Rapid swelling within hours of injury
- Pain and difficulty weight bearing
- Knee feeling unstable or giving way
- Loss of full knee range of motion (ROM)
If these symptoms sound familiar, getting an assessment from a physiotherapist is crucial.
Early intervention sets the foundation for a successful long-term recovery.
DO ALL ACL TEARS / RUPTURES NEED SURGERY?
No, surgery is not always necessary even after a complete rupture of the ACL.
While some athletes choose surgery (ACL reconstruction) to return to high level sport, many can recover very well without surgery by undertaking a structured and effective ACL rehabilitation program with a physiotherapist.
Research shows that up to 50% of ACL tears can be managed successfully with non-surgical physio rehab, especially if your sport or activity level is less demanding.
NON-SURGICAL MANAGEMENT OF ACL TEARS
Some people do very well without surgery and it is dependent on factors such as age, activity level, lifestyle goals, severity and if you are considered a “coper” or “non-coper”.
WHO IS A COPER?
These are the people who function well without an ACL. Even though the ligament is torn, their muscles and movement patterns adapt to stabilise the knee.
With the right physiotherapy (i.e. strength, balance and neuromuscular training), copers can often return to sport or their active lifestyles without surgery.
For example: a social netball player who strengthens their knees, hips, glutes and hamstrings might find that they no longer feel their knee “give way” even with quick changes of direction.
WHO IS A NON-COPER?
These are people who struggle to stabilise the knee without an ACL. The knee frequently feels unstable, buckles or gives way during daily activities, not just during sport.
In these cases, physiotherapy may help, but surgery is usually recommended for long term stability.
For example: someone who feels their knee buckle even when stepping off a curb or walking downstairs is more likely a non-coper and may benefit from ACL surgery.
HOW DO YOU KNOW WHICH ONE YOU ARE?
A physio can assess this through strength testing, balance drills and movement screening. Often a short course of rehab is trialled to see if you can become a coper before deciding on surgery.
6 SIGNS YOU MAY NEED AN ACL RECONSTRUCTION
- Ongoing knee joint instability (i.e. giving way)
- Persistent swelling and inflammation
- Difficulty to regain knee ROM (i.e. fully straighten or bend)
- Pain that doesn’t settle and continues to affect your activities
- Difficulty to weight bear
- Visible knee deformity
If you have given your ACL physio rehab a good shot, but continue to experience these symptoms, it’s now time to consider speaking to an orthopaedic surgeon to determine if you need an ACL reconstruction.
TIMING OF ACL SURGERY
Surgery isn’t always urgent. Many people first undertake “prehab” with a physiotherapist to reduce swelling, maximise strength and improve the overall success and outcomes after reconstruction surgery.
THE ROLE OF PHYSIOTHERAPY
Whether you choose surgery or not, physiotherapy is essential to help restore mobility, control, strength, flexibility and overall function to your knee.
OUR 4 STEP “STABLE KNEE” METHOD
- Early stage – reduce knee pain & swelling
- Mid stage – restore knee strength & mobility
- Late stage – sports specific training
- Final stage – return to activity assessment
WHEN SHOULD YOU SEE A PHYSIO FOR AN ACL INJURY?
If you’ve injured your knee, it’s better to get checked sooner rather than later.
Early physiotherapy makes a huge difference in your recovery, whether you choose surgery or not.
Even if you are not sure that it’s an ACL injury, getting an assessment helps you avoid long term issues like arthritis or further knee damage.
👉 Book in for our “Stable Knee” Method today and start moving with confidence
