The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee that requires surgical reconstruction. It is a very important ligament for stability, during both static and dynamic activities. It’s primary purpose is to stop the tibia anteriorly translating (moving forward) in relation to the femur. Due to its importance as a knee stabiliser, an injury can be devastating for athletes, and those who lead active lifestyles.

The ACL is usually damaged during high level sports such as basketball, football or skiing. A tear occurs when the knee is overextended, hit from the side or stretched beyond its normal limit during turning, running and changing direction. ACL tears may be treated conservatively or surgically. This will be decided on an individual basis, usually on the advice of an orthopaedic consultant. Regardless of the approach taken, rehabilitation is an essential aspect of recovery and return to sport.

ACL rehabilitation commences with an acute stage aimed at reducing swelling, pain and inflammation and increasing range of movement. At this point ice, soft tissue massage, manual mobilisation and a stretching program have all been found to be beneficial. Historically if the knee was surgically managed the movement allowed in the knee would be significantly limited post surgery by the surgeon to protect the repair. However, evidence now suggests that achieving full extension in the knee quickly after surgery is a big indicator in prognosis. This means that physiotherapy now starts much sooner, working with the patient to achieve full movement quicker and reduce the development of scar tissue.

The intermediate phase emphasises strength and stability in the knee and the surrounding joints and muscles. The type of exercises used to achieve this have evolved in the past few years. The belief that high level strength training is required to build up muscle has now in part been superseded. Physiotherapists now look to correct the quality of the movement, the coordnation and the rhythm. This allows for greater control and awareness of the body movement. This is known as neuromuscular training.

Only once the knee and surrounding muscles have achieved sufficient strength and stability is it appropriate to begin the recovery phase of rehabilitation. Only at this point is the knee ready for functional exercises such as running, jumping, turning and a return to sport. ACL rehabilitation can be a challenging journey, but with a knowledgeable therapist and perseverance, pre-injury performance is achievable.

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This post has been written by physiotherapist Zara Goodier. Need to get in touch with Zara and the team? Click here to get in touch!

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