ACL Injury Treatment & Rehabilitation Melbourne

Injury to the ACL occurs most commonly in high intensity change of directions sports like football, netball, soccer or skiing. Most injuries occur as a result of a player’s own movement, like an awkward landing or missed step. But, some injuries may involve contact from an opponent or object. People who have injured an ACL often describe a sensation of a pop, followed by pain and a sensation of instability in the knee or giving way when trying to get up or walk or run after the injury.

The Anterior Cruciate Ligament (ACL) is an internal ligament in the knee that connects the two main bones in the knee (femur and tibia). Although the ACL provides stability to the knee to help us to do many activities, there are many other structures (muscles, other ligaments) which also assist.

Our approach to ACL injuries

At Complete, we pride ourselves on being at the cutting edge of ACL injury management. Through La Trobe University, the clinic has contributed to a large volume of ACL research (e.g. here and here), including innovative rehabilitation approaches (e.g. here and here) and development of patient resources (here).

We have been one of the lead clinic sites in La Trobe University’s recent large NHMRC funded ACL rehabilitation trial. Our experienced clinicians see a high volume of people following ACL injury, and given our expertise we are regularly consulted for second opinions in difficult and challenging cases.

We will work closely with you throughout your ACL rehab journey to support you to get back the things that are important to you. Book a physiotherapy appointment at our Melbourne clinic at 656 Bridge Rd, Richmond.

ACL management pathway decision making

The first step in successfully managing your ACL injury is deciding on your management pathway. Whilst surgical reconstruction of the ACL has been considered the gold standard in the past, there have been some exciting recent developments in our understanding of ACL rehabilitation, and the ACL itself which have opened the door to other management pathways.

There are three main pathways to consider following an ACL injury:

Non-surgical rehabilitation
Surgical re-construction + rehabilitation
ACL healing protocol + rehabilitation (including the Cross bracing protocol)

Not all pathways are suitable for everyone. Our physiotherapists take the time to make sure you understand these options and what’s involved to help you to make the right decision for you and your circumstances.

For more information on these pathways and the important considerations around making decisions, see Tim Trevail’s blog here.

ACL Rehabilitation

Rehabilitation following ACL injury can be a long and involved process, but it can differ considerably based on variables such as your chosen pathway (see Management pathway decision making), surgical approach (if you choose this route) and your goals.

Rather than adhering to timeframes to progress through rehabilitation, the rehabilitation following ACL injury is broken into phases. Each phase will have milestones to achieve before moving to the next phase. Some pathways may have additional phases, and some people may spend longer on particular phases than others. But it is important to progress through the phases in turn based on your chosen pathway and goals. See the figure below for an outline of the phases of rehabilitation for each pathway.

It is important to understand that it is always possible to move to the surgical reconstruction pathway later, even if you have opted for one of the other pathways initially. There is no reported difference in outcomes of a delayed surgical reconstruction.

Return to sport testing

The return to sport following ACL can be an exciting, but anxiety inducing step. The risk of re-injury returning to sport is real but, achieving certain functional and psychological milestones based around you and your goals can reduce the risk of re-injury.

At Complete. Physio Exercise Performance, our clinicians will design a return to sport testing battery around you and your goals. Testing may include:

Clinical Testing

Swelling
Range of motion
Knee stability

Functional Testing

Horizontal hop (for distance tests)
Vertical (for height tests – using a force plate)
Agility (side hop and sport specific movements)
Balance

Strength Tests

Strength endurance testing
Repetition maximum testing
Dynomometry

Psychological Testing

Return to sport readiness questionnaires

All testing is compared between limbs, and also to normative values to give a picture of return to sport readiness.

Learn more about how we treat knee pain at Complete.

Do ACL injuries require surgery?

February

ACL Injury Decision Making: Is the knife always needed?

Common questions

ACL FAQs

Do I have to have surgery?

No. There are other pathways for people recovering from ACL injury that do not involve surgery. However, your choice of pathway may depend on several factors which you should discuss with your physio and other members of your healthcare team.

Who should I have as part of my healthcare team when recovering from an ACL injury?

Your healthcare team will usually include a GP, Physiotherapist (or another musculoskeletal clinician skilled in the management of ACL injuries), and in some cases a Sports Doctor and/or Surgeon. Even if your preference is to not have surgery, a discussion with a Surgeon or Sports Doctor may be an important step to gather all of the available information and opinions in your case so you can make informed decisions. Your physiotherapist can help you decide who else may be appropriate to see, but the most important thing is that you are comfortable each of these members of your team.

If I don’t have surgery, can I still get back to playing sports?

Yes. Some sports definitely ask a lot more of the knee, but there is an increasing number of examples of people returning to high level sports without an ACL, including high demand sports that require pivoting and landing. No matter what sport you are hoping to return to, it is important that the later stages of your rehab involve drills that mimic the demands of your sport to ensure you have adequate strength, power and control to return safely.

If I have injured my ACL, will I get osteoarthritis in the future?

Traumatic joint injury is a risk factor for osteoarthritis. Although not everyone who has an ACL injury will develop osteoarthritis, current statistics suggest that approximately 50% of people who have an ACL injury will have some signs of osteoarthritis on medical imaging within 10 years. It is important to note that not everyone with osteoarthritic changes on medical imaging will have symptoms or disability associated with these changes, and also, there are many strategies within your control to manage any symptoms should you develop them. For more information, see our knee pain page.

Will having surgery decrease my risk of developing osteoarthritis?

No. Current research suggests that the rates of osteoarthritis development after ACL injury are the same whether you have a surgical reconstruction or not.

How long will it take me to get back to sport after ACL injury?

This will be dependent on several factors including your chosen management pathway, and also your goal sport. Additionally, rehabilitation following ACL injury is more “phase-based” rather than time-based, meaning progression through the phases is reliant on you achieving certain levels and milestones rather than your time since injury or surgery. However, on average the rehab journey for someone having reconstructive surgery or going through a bracing protocol is 9 to 12 months, and the average rehab journey for someone going through a non-surgical pathway is 3 to 9 months.

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ACL Injury