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ACL management

Conservative management or Surgery?

The decision on whether to have surgical intervention will depend on numerous factors such as:

  • Age

  • Desire to continue with sport

  • Occupation

  • Associated other injuries e.g meniscus injury

  • Degrees of knee instability- i.e is the knee giving way a lot

  • Ability to commit to a long term rehabilitation programme

If you have torn your ACL skiing and would like to return to the slopes surgery will be recommended to ensure your knee has enough stability to withstand falls and twisting

What happens in an ACL reconstruction?

1. The hamstrings, Illiotibial band or patella tendon is harvested and is prepared to be a graft

2. The torn ACL is removed and is replaced with the new graft, which is then fixed into place; attaching the femur to the tibia

You will normally be able to go home the same day of your surgery and you will be given crutches which you usually only have to use for a couple of days

How long does it take after surgery to return to sport?

  • Usually around 6-12 months if you are committed to your rehabilitation programme; your physiotherapist and surgeon will be able to guide you on this


  • It is important to start rehabilitation soon after your injury as your operation can be weeks/months later by which time if pre op management/exercises are not followed the knee can become stiff and weak. If the knee is stiff and weak it can make progress after surgery slower and therefore your return to sport can be delayed.

  • Physiotherapy will also begin immediately after your operation and your physiotherapist will help you develop a personal exercises programme, progress your exercises and get you prepared to return to sport

Pre op management:

  1. Pain and inflammation control

  • Consider taking anti- inflammatorys such as ibuprofen to help reduce the swelling

  • Try to ice your knee regularly for around 15 minutes each time

  • If you are experiencing a lot of pain which is not being relieved by over the counter medications speak to your doctor who will be able to prescribe you stronger pain medications

  • Your physiotherapist may also use other modalities such as ultrasound to help with the inflammation/pain

2. Normalizing your gait

- Try to normalize your walking pattern as the pain reduces

3.Keeping you muscles strong

  • When you tear your ACL you loose some of the stability of your knee- it is therefore very important that you support your knee by keeping your muscles strong- in particular the quadriceps, hamstrings, calf and hip muscles

  • Try to keep yourself fit and your muscles strong by doing gentle exercise such as walking, cycling and swimming (but no breaststroke)

4.Preventing your knee becoming stiff

  • Try to keep your knee mobile and once the swelling has reduced you should be aiming to regain the full movement of your knee.

You can follow the exercises below to help you keep your muscles strong and prevent your knee becoming stiff

Pre op exercises for when the pain and inflammation has reduced

1. Heel slides- helps you gain full flexion of your knee

- Lying on your back and whilst keeping you heel in contact with the bed/floor slide your heel up as far as you can towards your bottom until you can feel a stretch on the front of your knee

- You can hook a dressing gown tie or belt around your foot to help you pull your knee up

2. Leg hangs- helps you gain full extension of your knee

- Place a rolled up towel under your foot and let your knee straighten

3.Quadriceps (thigh muscles) contractions/strengthening

- Lying on your back with your knee extended try to push your knee downwards to touch the bed- you should feel your quadriceps contracting

- Hold this position for 5 seconds. Repeat 15 times

4. Straight leg raises- also helps increase the strength of the quadriceps

- Lying on your back, with you leg fully straight lift your leg about 10cm of the bed. You should feel your thigh muscles contracting

-Try to hold this position for at least 5 seconds and then slowly lower your leg back down. Repeat 15 times

5. Straight side leg raise- increases strength of hip abductors (muscles around hip)

- Lying on your side with your injured leg on top

- Tighten your quadriceps and lift your leg about 20cm of the bed

- Try to keep your knee and hip straight and in line with the rest of your body

- Hold for 5 seconds and then slowly lower your leg back down. Repeat 15 times

6.Bridging- helps strengthen your hip, core and hamstring muscles

-Lying on your back with your knees bent

-Slowly raise your bottom of the bed, squeezing your glutes together as you do this. Then slowly return to the starting position

-Repeat 15 times

7. Calf raises

- Rise up and down on your toes slowly

- Repeat 15 times

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