What an ACL injury actually is
The anterior cruciate ligament (ACL) is one of the four major ligaments stabilising the knee. ACL injuries usually happen during sport — football, netball, basketball, soccer, skiing — and often involve a twisting movement on a planted foot, a sudden change of direction, or a landing from a jump. Some people hear or feel a "pop" at the time. Swelling is usually quick and significant in the first 24 hours.
Surgery vs no surgery
Not every ACL tear needs surgery. The decision depends on factors including: how unstable the knee feels in daily life, what sports or activities the person wants to return to, age, other injured structures (meniscus, other ligaments), and what's important to them. There's growing evidence that some people do well with structured rehabilitation alone — but for many active patients, particularly those returning to pivoting sports, reconstruction is the more common pathway. Your orthopaedic surgeon and physiotherapist will discuss the options with you.
The phases of rehabilitation
Pre-operative (or early stage)
Whether or not surgery is planned, the first stage is restoring range of motion, settling swelling, and rebuilding basic quadriceps and hamstring strength. Going into surgery with a quiet, mobile knee tends to lead to better recovery.
Early post-operative (0–6 weeks)
Focus is on protecting the graft (if reconstruction was done), restoring full extension, regaining flexion gradually, and starting to load the leg. Crutches are commonly used early; weight-bearing progresses based on surgeon protocols.
Middle phase (6 weeks–3 months)
Building strength, balance, and movement quality. Single-leg work, controlled jumping, change of direction at low loads.
Late phase (3–9 months)
Sport-specific work — running, jumping, cutting, plyometrics. Gradual reintroduction of pivoting and contact, when ready.
Return to sport (typically 9–12 months minimum)
Modern guidelines emphasise meeting strength, hop test and movement quality criteria before unrestricted return to pivoting sport — not just hitting a calendar date. Outcomes vary between individuals.
What rehab looks like week to week
Sessions usually combine assessment, hands-on work if needed (early on, often less later), and structured exercise. Home programmes are central — what you do between sessions matters at least as much as what happens in the clinic. Loading is progressive and individualised.
The mental side of an ACL recovery
Long rehabs are demanding. Many people experience frustration, fear of re-injury, or a dip in confidence. This is normal, and there's good evidence that addressing the psychological side of rehab supports better outcomes. Some patients benefit from psychology input alongside physiotherapy.
Reducing reinjury risk
The first 12 months after return to sport are the highest-risk period for reinjury or contralateral ACL injury. This is one reason structured prevention programmes (like Knee Control or PEP) are recommended for athletes returning to pivoting sport, often continued long after formal rehab ends.
Practical notes
Our team works with patients across the full ACL pathway — from acute injury through to return-to-sport testing. Suitability and timeframes vary based on your specific situation. The starting point is usually a phone enquiry so we can match you with a physiotherapist experienced in knee rehabilitation.
← Back to all articles
