General
VKB Recovery
April 5, 2022
An anterior cruciate ligament (ACL) rupture is an incredibly common injury, especially among athletes. In our first blog post on "Rehab and Prevention of the Anterior Cruciate Ligament," we dive into the anatomy of the knee and its core structures. In our second blog post , we take a closer look at the incidence, costs, and long-term consequences of an ACL rupture, while diving deeper into the risk factors and mechanisms of injury.
In this blog post, we want to spotlight the treatment and rehabilitation journey following an ACL injury. The rehabilitation path for isolated ACL injuries and combined injuries involving the meniscus or collateral ligaments is highly similar. For this guide, however, we will focus on an isolated ACL injury.
After sustaining an injury , an athlete generally has three main paths forward. Deciding which route to take is a collaborative decision made with your treating physician, carefully weighed against your individual goals, needs, and athletic demands:
Immediate surgery
Conservative (non-surgical) treatment
Initial conservative treatment followed by surgical reconstruction if needed
Scientific research strongly recommends surgery with surgical reconstruction of the torn ligament for athletes aiming to return to high-risk sports.
Successful ACL rehabilitation—whether following reconstruction or chosen through a non-surgical path—is a demanding, long-term journey that requires patience, dedication, and intensive outpatient physical therapy. A successful surgery is, at best, simply the foundation for an optimal recovery process. Without dedicated rehabilitation, returning to your sport is simply out of reach.
Throughout tissue healing and the entire rehabilitation process, several key physiotherapeutic goals are pursued:
Graft-bone healing of the implant
(Revascularization of the cruciate ligament)
Pain relief & reducing swelling
Restoring range of motion (mobility) both tibio-femoral and patello-femoral
Restoring proprioception and strength
Full comfort and zero pain in daily activities
Elevating you back to peak performance in your specific sport
An optimal ACL rehabilitation plan must be customized to the individual, the acute stage of the injury, and your personal athletic goals, as every body responds uniquely to the process.
In addition to top-tier physical therapy, a clear, solid understanding of your own healing journey is absolutely essential.
ACL Rehabilitation
The ultimate ACL rehabilitation starts immediately after the trauma with pre-operative rehab. The goal of this phase is to boost your baseline strength and joint mobility before you even head into surgery. This sets a powerful foundation that will majorly accelerate your recovery timeline post-surgery. During this phase, we focus heavily on knee extension and joint mobility, alongside building up the strength of your quadriceps muscle. Specifically, unleashing and actively engaging the Vastus Medialis through targeted exercises is key.
Quadriceps strengthening before surgery is absolutely critical. Studies have shown that a pre-surgery deficit of 20% in quadriceps strength can result in a significant strength deficit lasting up to two years post-surgery [1].
The second phase of rehabilitation starts immediately after surgery. During this time, managing swelling and pain is the top priority. Simultaneously, we focus on re-activating the muscles so they can regain active control of the knee as quickly as possible. Once the knee can be actively stabilized during daily movements and you can walk with a normal, natural gait, you can usually say goodbye to your crutches. Our physiotherapists at BodyLab are here to guide you through this step personally and individually.
From here on, the goal is to systematically and safely ramp up the load on your knee while regaining full range of motion. The focus shifts to lower extremity mobility and coordination. Note that while we target the injured leg, both legs must be trained. The strength and coordination of the uninjured leg also decline during periods of rest. Until you reach full weight-bearing status, forearm crutches can occasionally be used as temporary support.
Achieving full weight-bearing capacity in everyday life is an incredible milestone in your rehabilitation! However, clear deficits in strength, coordination, endurance, and load tolerance will still remain. That is why phase four continues to push your strength and coordination limits—now accelerating with heavier weights and sport-specific training movements.
The final phase is all about sport-specific conditioning and preparing for full, unrestricted performance in contact sports and high-risk maneuvers. Here, training shifts heavily to the neuromuscular level. This includes jump training, maximum power, and explosive strength. We utilize heavy loads and rapid, dynamic movements. By this point, a flawless physical foundation is a must so your structures can easily handle the intense demands.
The Bottom Line
An anterior cruciate ligament injury is a serious challenge, but one that can be successfully mastered. Whether you choose a conservative approach or surgery, a dedicated rehabilitation program spanning several months is absolutely essential. A versatile, customized training program supports your body's natural healing process and gets you back to your peak physical self. Use the phases outlined above as a guiding framework rather than a rigid program. Through consistent rehabilitation and disciplined training, 83% of elite athletes successfully return to their sport after ACL reconstruction, competing in their first match just 6 to 13 months later [3].
Whenever you need us, we are here to support your comeback!
Your BodyLab Team – Your Specialists for Recovery & Performance
Osteopathy and Physiotherapy | Rehabilitation and Training
Zurich Altstetten
Bibliography
Nicky van Melick, Robert E H van Cingel, Frans Brooijmans….2016 Review
[2] Follow-up treatment scheme and return to sports after cruciate ligament reconstruction – Vavken, Sadoghi, Valderrabano, Pagenstert
C. H. Lai, C. L. Ardern, J. A. Feller, and K. E. Webster
Br. J. Sports Med., vol. 52, no. 2, pp. 128–138, 2018.
Cover Image Credit
No machine-readable author provided. Lucarm84 assumed (based on copyright claims)., Legamenti crociati, licensed under public domain, details on Wikimedia Commons
