Management of ACL injury

Understanding ACL injury and management options

understanding ACL injuries and management options smallThe anterior cruciate ligament or ACL is a key ligament in the inside of the knee that helps to stabilise the knee joint. Injuries are common, especially among athletes involved in sports that require sudden stops, jumps, and changes in direction. On injury it can be partially torn, or totally torn, called a complete rupture.  Injury can occur at any age. 

An ACL injury is a significant injury. It can result in significant pain, lack of stability in the knee, and decreased ability to partake in activity and sport.

Accurate diagnosis is essential for effective rehabilitation to take place. Previously ACL reconstruction in surgery was the next step. However we are increasingly seeing that there are successive non operative options available. If you suspect an ACL injury it is essential you see a health practitioner. As sports physios we will be able to assess your knee.

Causes and Symptoms of ACL injury

causes and symptoms of ACL injury smallACL injuries can result from various mechanisms, including:

  1. Direct Impact: A blow to the knee can stretch or tear the ligament.
  2. Non-Contact Injuries: These occur when no contact with anyone else is involved. This commonly occurs when an athlete changes direction rapidly or lands awkwardly from a jump.

Common symptoms of an ACL injury include:

  • A loud "pop" sound at the time of injury
  • Severe pain and swelling in the knee
  • Instability or a feeling that the knee may "give way"
  • Reduced range of movement

Diagnosis

Diagnosing an ACL injury typically involves:

  1. Physical Examination: an  assessment of your knee and specific testing from your sports physio or doctor
  2. Imaging Tests: MRI scans are commonly used to confirm ACL tears and evaluate any associated injuries which may have occurred to the cartilage or other ligaments.

Management Strategies

management of ACL injury smallThe management of an ACL injury can be categorized into conservative treatment and surgical intervention. Surgery is NOT your only option

Conservative Treatment

Many people are managing well after ACL injury with physio alone and no surgery needed.  This is know as a “coper”, someone who copes well with no ACL.  

Cross bracing

A relatively new study is looking at the capacity for the ACL to heal.  Early trials show the ACL can heel with a period of bracing keeping the knee bent to 90 degrees and non weight bearing for several weeks.  Over the following weeks the knee range of movement is slowly allowed to increase using a hinged brace to block excessive movement. Rehabilitation as per a knee coper then follows.

We suggest you use this guide from Melbourne University to help you decide what may be the best approach for you surgery or not: Weigh up the pros and cons of treatment options

Surgical Intervention

For athletes or individuals with complete tears who wish to return to high-level activities, surgical intervention may be necessary and still remains the more frequently opted for intervention. The most common surgical procedure for ACL injuries is arthroscopic reconstruction, which involves:

  1. Graft Selection: Surgeons can use a graft from the patient’s own tissue (autograft, frequently the hamstring or patella tendon) or donor tissue (allograft) to replace the torn ligament.
  2. Arthroscopy: This minimally invasive procedure allows surgeons to visualize the inside of the knee and make precise repairs.

RehabilitationNo matter which option you opt for, a highly structured rehabilitation program is critical for successful recovery moving forward. Your physio will carefully assess you throughout making sure you only progress when you are ready.

Rehabilitation typically falls into 4 phases:

  1. Phase 1: Early Recovery 
    Focus on reducing swelling (where relevant), restoring range of motion, and beginning gentle strength exercises.
  2. Phase 2: Intermediate Recovery (2-6 Weeks)
    Emphasis shifts to increasing strength, balance, and stability through more intensive physical therapy.
  3. Phase 3: Advanced Recovery (6 weeks to 6 months)
    Introduce sport-specific drills and agility training while continuing to strengthen the knee.
  4. Phase 4: Return to Sport (6-12 Months)
    Athletes gradually return to their sports with an emphasis on functional movement patterns, agility, and sport-specific skills.

Long term management

Many people don’t realise the importance of looking after their ACL affected knee long term. It is essential that you continue to look after your knee, maintaining strength and function of the knee long term. Early osteoarthritis can be a risk factor after ACL injury.  Take the time to look after your knee and seek guidance from your physio when required. 

Prevention Strategies

ACL rehab and recovery smallPreventing ACL injuries is just as crucial as managing them. Effective prevention strategies include:

  • Strength Training: Focusing on the muscles around the knee, particularly the quadriceps and hamstrings.
  • Neuromuscular Training: Incorporating exercises that optimise balance, coordination, and agility.
  • Proper Techniques: Teaching athletes how to land correctly, pivot safely, and cut efficiently.

Much of this can be achieved with a good dynamic warm up – speak to your physio to learn more. This is a must as part of your sports preparation and has been shown to reduce your risk of ACL injury!

Conclusion

The management of ACL injuries requires a multi-faceted, multi-disciplined approach tailored to the individual’s needs and goals. Whether opting for conservative treatment or surgical intervention, a structured rehabilitation program run by your physio is essential for effective recovery and returning to optimal function. 

Prevention strategies should be a priority for athletes to minimize the risk of ACL injuries no matter if you have or have never had an ACL injury.