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Anterior Cruciate Ligament (ACL) Injury

What is an ACL injury?

Your knee is made up of 4 main ligaments – anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). These ligaments attach your thigh bone (femur) to the two bones in your lower leg (tibia and fibula), providing strong support and stability for the knee joint.

An ACL injury is common during sports that involve sudden stops or changes in direction, twisting, or jumping and landing motions – e.g. basketball, netball, soccer, skiing, rugby, touch football and gymnastics. Injuries to the ACL can also occur in conjunction with other structures within and around the knee, such as the articular cartilage, MCL or meniscus.


Common Presentation:

An ACL Sprain is graded on a scale from 1- 3 depending on the severity of the injury:

  • Grade 1 – the ACL is stretched or mildly damaged but is still intact and can therefore provide a small amount of stability to the joint

  •   Grade 2 – the ACL is stretched or partially torn, decreasing the stability of the joint

  • Grade 3 – the ACL is completely ruptured and requires surgical repair

Common Symptoms after an ACL injury can include:

>> Pain, swelling, difficulty walking and reduced range of motion.

Our Treatment Focus

IMMEDIATE: Rest, ice, compression, elevation and referral (RICER). Ice should be applied for 15 minutes at a time, every hour for the first 48-72 hours, however not applied directly on skin. A compression bandage should be worn and the leg rested in an elevated position to reduce the bleeding, swelling and damage in the joint. Advice should be sought from a medical professional, such as a Physiotherapist or GP as soon as possible. You may be sent for imaging to determine the severity of your injury.


POST SURGERY:  In some circumstances, surgery may not be required and a Physiotherapist guided rehabilitation program should commence. Surgical reconstruction of the ACL may be deemed necessary, and will therefore be performed by an orthopaedic surgeon.

A rehabilitation program will commence immediately after surgery and aims to reduce pain, restore range of motion and increase the strength of the surrounding muscles to support the knee joint. Physiotherapy is crucial to allow you to return to all your daily activities and sport.

Initial Exercise

(Recovery from Surgery)

Get the knee straight and activate to quadriceps

Progress to....

Regaining ROM (heel slides) + improving muscle strength (mini squats) + single leg balance

At-home Exercise Recommendations

Preventing ACL sprains is a hot topic that has recently been studied extensively. Current evidence supports the use of preventative exercise programs to reduce to risk of sustaining an ACL injury during the sporting season. An exercise program incorporating plyometric, balance, coordination, agility and strengthening exercises will assist an athlete to be able to stay fit and strong, minimising the risk of injury.

Please note that you should always consult with your doctor or physiotherapist prior to attempting these exercises. Alternatively, feel free to call us on 1300 16 16 88 to speak to one of our physiotherapists to see whether these exercises are suitable for you.

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