The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads.
The ACL provides approximately 85% of total restraining force of anterior translation. It also prevents excessive tibial medial and lateral rotation, as well as varus and valgus stresses.
Basically, the ACL helps maintain optimal knee kinematics.
The ACL is critical for stability of the knee joint. Its function is essential for many sports and specific activities such as changing direction, weaving, pivoting, or kicking. Despite being a largely preventable sporting injury that typically leads to lifelong repercussions, including osteoarthritis, Australia has the highest reported rates of ACL injury and reconstruction in the world.
Over the past 15 years, the rate of reconstruction in Australians under 25 years of age has risen more than 70%, with the greatest increase among children under 14, according to research published in the Medical Journal of Australia.
So, why does it happen?
The ACL is often ruptured during a pivoting or twisting movement, usually while playing sport. It can also be caused by a blow to the outside of the knee when the knee is bent. Sometimes, it is caused by hyper-extending (over straightening) the knee, such as when jumping up and landing awkwardly.
More commonly, ACL Ruptures are repaired through surgical procedure. ACL surgery restores the rupture ligament using a graft from either the hamstring (semitendinosus) or patella tendon of the patient – however other grafts are also possible. Graft choice will depend on the surgeon’s recommendation and is individualised to the specific patient and context.
Return to pre-injury status takes approximately 12 months.
The goal is to restore the function, integrity and strength of the ligament as well as develop strength, proprioception, range, neuromuscular control, and a pre-injury level of sport specific ability.
Progression through each stage of rehabilitation should be GOAL based rather than time based. We have created a general guideline outlining specific goals and treatment guidelines for each stage of the rehabilitation process. In summary the stages include:
Stage 0 – Prepare For Surgery
For optimal recovery from surgery, it is important the rehabilitation process starts prior to surgery regaining strength and mobility measures.
- Pain management
- Restore range of motion
- Reduce swelling
Stage 1 – Recovery From Surgery
For optimal recovery it is recommended that patients have regular consultations/treatment sessions with the Physio 2-3x per week in the initial post op stage.
- Restore knee extension
- Normalise Gait patterns
- Quad activation
Stage 2 – Strength and Neuromuscular Control
This stage of rehabilitation physiotherapy consultations should be maintained at a minimum of 2x weekly.
- Increase lower single leg strength side to side 90%
- Improve neuromuscular control + functional patterning
- Introduction to running mechanics & plyometric drill efficiency
Stage 3 – Return to Running
At this stage of the rehab, it is important the physiotherapist has extensive strength & conditioning knowledge and accreditations to facilitate an adequate and reliable program. Treatment is predominantly S&C and little if any hands-on treatment.
If the physiotherapists don’t have exercise programming history – it is recommended, they refer on.
- Progress plyometric capacity – specifically single leg hops in all directions
- Increase running intensity + volume (aerobic output)
- Continue to build single leg functional strength patterns
Stage 4 – Sports Specific Training
- Restore top end speed/acceleration
- Improve change of direction capacity/tolerance
- Resume full training “sport specific training” if applicable
Stage 5 – Return to Sport
- Strength gains 105%+
- Functional movement patterns = excellent
- Full training capacities – monitor over the 3months
- Return to sports performance
The journey back to sport can feel like a long one at the outset, but with the right plan and team around you, there is no reason not to hope for a great recovery and exciting future back in the game!
Want To Know More?
We’d suggest contacting our team at Precision Physio, so that we can help you with your individual case.
How Do I Book An Appointment?
We’re taking the health of our clients, members and staff very seriously and our preference would be for you to call to book an appointment so that we can make sure to explain our approach to keeping you safe. You can call any of these numbers to schedule a session:
- Precision Physio Concord: 02 9736 3950
- Precision Physio St Marys: 02 9623 2220
- Precision Physio Mt Druitt: 02 9188 2552
Evolving with the current environment, we are also now offering online appointments, meaning that we can support anyone who is unable to leave their home. Sessions are done via our state of the art Telehealth system and as long as you have a laptop or tablet with an inbuilt camera, or a phone with camera, we can help!
To learn more about online consultations, please call us on any of the numbers listed above.