The ACL (anterior cruciate ligament) is one of the most important ligaments in your knee joint. It connects the shin bone (tibia) to the thigh bone (femur) and works with three other ligaments to provide stability and balance to your knee. The ACL’s job is to prevent your knee from over-rotating or over-extending. When the knee joint experiences increased pressure during high intensity sports such as AFL or netball, which require fast pivots, forceful landing and sudden speed, the ACL is vulnerable to injury such as a tear or rupture. If you have suffered an ACL injury, this guide will give you a full understanding of your ACL treatment options, including advances in ACL surgery and suggestions on how to manage your injury and related symptoms along t

ACL tear severity levels

ACL tears are graded according to the level of injury, each requiring a different approach to treatment and recovery. The grading system helps medical professionals determine the most appropriate intervention as well as giving you a clear indication of how the injury will impact your knee stability.

Grade 1 – mild ACL damage, where the ligament is stretched but still provides adequate knee stability. This level of ACL injury is the most likely to heal on its own and respond well to conservative treatment

Grade 2 – stretched and partially torn ACL, resulting in some loss of knee stability and increased risk of further injury

Grade 3 – full ACL rupture, leading to significant knee instability and typically requiring surgical intervention

ACL injury diagnosis

General ACL injury symptoms include:

• A popping sensation

• Severe pain 

• Inability to continue activity or take weight 

• Swelling

• Feeling of instability

If you are experiencing any of these symptoms and suspect an ACL injury, consult your doctor and talk to one of our specialists if you are based in Australia.

At the time of injury, the ACL can usually be felt to ‘pop’ or ‘snap’, leaving the knee painful and swollen with a reduced range of motion. There is a feeling of instability when putting any weight on the affected knee. Your doctor will assess your condition and compare the functionality of your good knee with your injured knee. If there is a suspected torn or ruptured ACL, an X-Ray or MRI scan is a useful way to identify the extent of the injury, as well as to determine any other potential tissue damage. In some cases, a knee arthroscopy may be recommended. This minimally invasive procedure uses a small camera to get a clearer view of the ACL and the surrounding knee structure in order to assess the extent of the damage and to determine a treatment pathway. 

What to do immediately after an ACL tear

ACL treatment options will vary, and so it’s important to seek medical help as soon as possible in order to diagnose the injury. With some ACL injuries, you might still be able to walk with minimal pain or swelling, but leaving your injury undiagnosed can delay or impede a full recovery.

Rest and rehabilitation are crucial to recovery in the initial stages, as ACL treatment cannot begin until the knee has recovered function. Following the RICE method is the first step to help reduce any swelling and manage pain:

• Rest – avoid putting weight on your knee to allow it to heal

• Ice – apply ice packs for 15 minutes, several times across the day

• Compression – bandage your knee to reduce swelling

• Elevation – prop up your knee above the level of your heart as much as possible

Your doctor may recommend a knee brace or crutch for additional support as the main goal after injury is to get your knee functioning as normally as possible. Patients diagnosed with a low grade ACL tear may recover well with physiotherapy alone.

Your ACL injury treatment and recovery step-by-step guide

Your treating doctor will assess the extent of your ACL injury and talk to you about your personalised treatment options. Surgical ACL reconstruction is no longer the definitive treatment for ruptured or severely torn ACLs, as the ligament has been shown to grow back with as much pre-injury strength using high quality physiotherapy and rehabilitation. The appropriate treatment pathway will depend on the type of work you do, and the sports that you participate in. Your doctor will consider all the individual factors and consult with you before making recommendations. 

Partial ACL tear: diagnosis and recovery

• Your doctor will use several tests to determine the extent of the ACL tear, possibly including X-ray and MRI scans

• Your lifestyle and activity goals will all be taken into consideration

• Physio and rehabilitation are generally recommended for low grade ACL tears

• In more severe cases, surgery may be recommended to restore full function to the knee

• A full recovery can take up to three months

ACL rupture: diagnosis and treatment

• Your doctor will use several tests to determine the extent of the ACL rupture including X-ray and MRI scans

• The personalised treatment pathway will vary by patient 

• Younger patients returning to high level sport are more likely to be recommended ACL reconstruction, also known as knee reconstructive surgery

• It can take up to 12 months to make a full recovery after surgery

• Older patients are more likely to be recommended a conservative ACL management treatment pathway such as physiotherapy

• Non-surgical recovery can take a minimum of three months, but some instability symptoms may remain

• If the ACL has not healed as expected with conservative treatment, a surgical approach may be recommended 

Talk to a specialist about your options.

Pain management after injury

ACL injuries are undoubtedly painful, and the goal of all rehabilitation is to reduce the pain and swelling so that the knee can regain function. Restoring mobility and strength to the knee before surgery is crucial to maximising outcomes, and an important first step in the rehabilitation process.  

• In the initial stages, painful symptoms can be managed with over-the-counter medication such as paracetamol and topical creams

• Follow the RICE model (above) to minimise discomfort

• Your doctor may recommend stronger medication to help with the pain, along with a knee brace or crutches to stabilise the knee and reduce pressure

• Limit activities that aggravate the knee such as walking or standing

• Your doctor will prescribe gentle exercises to strengthen and stabilise the knee, and maintain joint flexibility

• Always talk to your treating doctor if the pain persists or worsens

ACL partial tear treatment

• The ligament is likely to heal with rest and physiotherapy 

• Surgery may be considered for younger patients, or those playing competitive sports (see below)

• Our interdisciplinary rehabilitation team will create a personalised rehabilitation program to be started immediately after the initial swelling and pain has subsided

• Restoring strength and flexibility to the knee is key to recovery

• Exercises should be completed several times daily at home, and under supervision

• Consistency is key to a good outcome

• Recovery can take up to three months depending upon your age, type of injury, and general health

ACL rupture treatment

• The ligament will not heal by itself and will require considerable physiotherapy treatment as a minimum

• Your doctor will consider your age, lifestyle and suitability for surgery

• With severe ACL ruptures, your doctor is likely to recommend ACL reconstructive surgery, also known as knee reconstruction surgery

• Surgery is generally performed 3-6 weeks after injury when the inflammation has subsided 

• Delaying surgery may increase the risk of damage to other parts of the knee, with the sustained instability potentially leading to early arthritis

• Our multi-disciplinary team will create an individualised pre-habilitation program to strengthen the knee before surgery, followed by a comprehensive rehabilitation program to be completed at home or under supervision

• Recovery can take up to 12 months depending upon your age, type of injury, and general health 

• Your doctor will advise when it is safe to return to sport without risk of re-injury

Preparing for ACL treatment 

Non-surgical ACL treatment

Committing to rehabilitation is crucial to ensuring the best outcome from your ACL injury. For low grade tears, and patients with a less active lifestyle, a comprehensive and personalised physiotherapy program is key to restoring your knee strength and functionality. It’s important not to rush the process and allow the ACL time to heal and strengthen.

• Stage 1 – Gentle exercises to regain motion and stability 

• Stage 2 – More advanced exercises to increase knee strength 

• Stage 3 – A focus on mobility and agility with a gradual return to sport 

ACL reconstruction surgery

During ACL reconstruction surgery, the torn ACL is usually replaced by a healthy tendon from another part of your body such as the hamstring, patella tendon or quadriceps. This is known as a graft.

Before surgery

• Strengthening exercises to improve knee strength and aid recovery 

• Any swelling and stiffness should have fully subsided

• Surgery generally takes place 3-6 weeks after the initial injury

• A final medical evaluation including imaging tests to accurately assess the ACL injury

On the day of surgery

• ACL reconstructive surgery is usually performed under general anaesthetic

• The repair is completed during a knee arthroscopy using small incisions, a camera and specialist tools to attach the new graft and repair the ACL

• After surgery, patients begin an individualised rehabilitation program 

• Patients may stay in hospital overnight and will need help returning home

Recovery 

Recovery from a partial ACL tear can take between 3-6 months following a personalised rehabilitation program.

Recovery from ACL reconstructive surgery can take up to 12 months and will depend upon your age and health coming into the operation.  Adhering to pre-habilitation and rehabilitation guidelines are key to maximising your surgical outcomes and restoring full function to your knee. The recovery process can be split into three key stages, and will be tailored to your individual needs by your treating physiotherapist.

Stage one (weeks 1-6)

• Goal: Reduce pain and swelling (RICE), restore mobility and activate muscles

• Wounds should heal within 10 days

• Gentle range of motion exercises will get the knee moving

• A knee brace may be recommended for stability

• Quad contractions and leg raises strengthen muscles while the ACL repair heals

Stage two (weeks 6-12)

• Goal: Restore full range of motion, increase muscle strength and improve stability and balance

• Stretching exercises will help increase flexibility

• Begin weight-bearing exercises such as squats and leg presses to strengthen supporting muscles

• Core exercises improve stability and balance

• Low-impact cardio such as swimming or cycling may be recommended

Stage three (3 months +)

• Goal: Restore agility and confidence to return to previous activities

• Increased resistance training improves strength and balance

• Sport-specific training can be incorporated under supervision

• A gradual return to running can increase in duration and speed

• Strength and conditioning exercises should continue

Diet recommendations

Fuelling your body with nutrient-rich foods will help aid your recovery:

• Protein foods (meat, dairy, eggs, fish) will help repair bones and muscles and strengthen immunity

• Vitamin C-rich foods (fruits, vegetables, berries) help your body make collagen, strengthening connective tissues

• Maintain calcium levels with dairy products, spinach, kale and chia seeds

• Vitamin D increases calcium absorption and can be found in orange juice and egg yolk

Re-injury prevention 

Once you have made a full recovery, it’s important to take good care of your new ACL to prevent re-injury – particularly if you are back playing sports. Continue on with your physiotherapy exercises as these will strengthen all the supporting muscles around your knee joint. Many sports teams also offer injury prevention programs that advocate for a good warm-up and stretch before play, followed by strength, balance and agility exercises. Maintaining form is crucial to ACL injury prevention.

Conclusion

Sports medicine is constantly working to understand more about ACL injuries and treatment pathways. Whether you're dealing with a mild sprain or a complete rupture, our experienced team is here to guide you through every step of your recovery journey. From initial diagnosis to personalised treatment plans, we understand that each patient's path to recovery is unique.

If you’re confused about your treatment options or concerned about coverage our specialists are here to discuss your situation and help you navigate the best path forward for your specific needs. We're committed to working with you to achieve the best possible outcome, whatever your circumstances may be.