So you have an ACL tear. What’s next?

What is the ACL

Your ACL is your anterior cruciate ligament; it is one of two cruciate ligaments in the knee. The job of the ACL is to stop the tibia (shin bone) translating anteriorly (moving too far forward), and rotating; The ACL also reduces valgus forces through the knee (being forced quickly into a knock-kneed position); This ensures the knee stays stable as you walk, run, and turn; pretty much any time you complete activities that require you to stand and move. 

How do I injure my ACL

ACL injuries in Australia have been rising over the last 20 years. These injuries generally occur during sports/activities that involve rapid changes of direction, changes in speed, and/or jumping and landing (e.g., soccer, rugby league, AFL, Snow skiing etc.). These non-contact activities increase force greatly through the knee, occasionally resulting in the ACL tearing; however, it should be noted that contact injuries (e.g., someone falling on or tackling your leg) can also lead to ACL injuries, it is just not as common.  

How do I know if I have injured my ACL

ACL injuries have many signs and symptoms, they are listed below:  

  • Audible pop or cracking sound  
  • Swelling generally occurs pretty quickly (within the first couple of hours), however, occasionally it can take 24hrs for swelling to show up. When this swelling does occur, there is usually a large amount. 
  • Initial feeling of instability in the knee – Once the swelling begins this often masks these feelings until the swelling reduces, at this time instability may recur.  
  • Sharp pain in the knee immediately after completing a cutting, turning, decelerating or jumping/landing movement.  
  • Reduced ability to bend or extend the knee to full ranges. 
  • The knee will generally become quite tender to the touch.  

What do I do if I think I have torn my ACL

When ACL injuries occur other knee injuries often occur at the same time. For this reason, it is important that you see a health professional as quickly as possible. Seeing a physio ASAP after a suspected ACL injury is super important in order to get a quick, accurate diagnosis. Early diagnosis and treatment is essential in order to get your knee back on track as quickly as we can. 

If the physio agrees that you have likely injured your ACL they will probably send you to your GP to get some scans (X-ray and/or MRI) to confirm the diagnosis. If these scans show that an ACL injury has occurred, then you will likely be referred to, or told to look into orthopaedic surgeons who work with knees, or even surgeons who work only on ACL injuries. You will be in contact with these health professionals for the next 6-12 months, and they will be in contact with each other to ensure you have the best possible treatment.  

Does the ACL tear need surgery

The short answer is no, not every ACL tear will need surgery. There is new research that shows that some ACL’s are able to heal and some people may be able to return to sport. However, for many ACL injuries surgery is the likely option. This is a big decision, you should talk to your physio, your GP, and your orthopaedic surgeon so you can make an informed decision about what is best for you.  

Do I need Physio for my ACL tear

Physiotherapy after an ACL injury is really important both before and after possible surgery. If you have physio before surgery, your outcomes after surgery will be much better and you will be able to progress quickly following surgery.  

What should I expect after surgery (ACL Rehab)

Physiotherapy after ACL surgery will generally consist of 6 phases, these are listed below with a description of each.  

Phase 1: Pre-Op (1-3 months) 

Initially physiotherapy will focus on reducing your swelling, increasing your range of motion in your knee, and getting your quadricep (front thigh muscles) muscles firing. This will be followed by general strengthening of your legs, with a big focus obviously being on your injured side. The more range of motion and strength you have before surgery, the better your outcomes are post-surgery.  

Phase 2: Recovery from Surgery 

After surgery, many of the goals are very similar to your goals before surgery. We really want to focus on reducing swelling, activating your quadriceps, and increasing your knee range of motion (especially getting the knee back to straight). It is super important to start on these goals really quickly, because the quicker we can reach these goals the quicker we can start the fun stuff; That is getting you back to the sports/activities that you love whilst reducing the chance that you injure your ACL again. 

Phase 3: Regaining Strength and Neuromuscular Control 

Once phase 2 has been completed, the main goals will be to recover your strength and neuromuscular control. This involves a combination of lower limb strengthening exercises, balancing exercises and a combination of the two (e.g., attaining good control when doing a single leg squat).  

Phase 4: Running agility and landings  

Phase 4 often begins around the 3-month mark. However, this timing will depend on how quickly you progress through the other phases. Remember, this is a marathon, not a sprint, you do not want to progress too quickly when you are not ready, you want to make sure this doesn’t happen again.  

Phase 4 focuses on initially returning to running, this will begin with a light jog. This phase progresses from this up to short, sharp changes of direction and different kind of jumping and hopping tasks. These tasks will often differ depending on what you are aiming to return to.  

Phase 5: Return to Sport – usually a minimum of 9 months before return to sport occurs. Improved outcomes are often seen with 12+ month return to sport times.  

As the name of this phase suggests, this phase focuses on ensuring you are ready and keen to return to your specific sport. Specific aspects of this phase will be different depending on your sport. But your physio will help you to ensure you are the best you can be when returning to your sport.  

Phase 6: Prevention of Re-injury  

Phases 5 and 6 are often completed at the same, or at least similar times. There are many different ways that your risk of re-injury can be reduced. Your physio will work with you to ensure that your risk of re-injury is as low as possible by giving you a program you can complete at home and before sport.  

We have helped many local sports clubs in the local Peakhurst, Lugarno, Oatley and Riverwood areas rehabilitate their players from ankle injuries. Reach out to our experienced team to discuss.

If you would like to know more please click Here to book with one of our experienced Physios.

By Peakhurst Physio

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