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A torn ACL is a significant injury, especially for sports players. The Anterior Cruciate Ligament (ACL) is a band of fibrous tissue connecting the thigh bone (femur) to the shin bone (tibia). The primary functions are to limit twisting (rotational) forces through the leg, and to prevent forward movement of the tibia on the femur.

Signs & Symptoms

  • Severe pain, which can be vague in location

  • Inability to continue playing

  • Audible noise at time of injury such as a pop or snap or the feeling something has moved place

  • Sudden onset of swelling (within 1-2 hours of injury)

  • Possible giving way of the knee post-injury

  • Likely restricted movement (in particular extension)

  • Depending on damage to other structures, there may also be pain medially and laterally.

What Causes It?

The mechanisms by which the ACL can rupture include pivoting, changing direction, and on landing from jumping.  In snow sports, impact at high or low speeds, incorrect fall out techniques or a failed binding release can also result in damage to the ACL.

How to Self Manage

The knee will swell rapidly (within 1-2 hours following the initial injury), so the initial phase of treatment should be RICER (rest, ice, compression, elevation and referral to either a physiotherapist or Sports physician).  If weight bearing is too painful, the use of crutches may be necessary.


Upon suspecting ACL rupture, your physiotherapist will immediately refer you for further assessment and investigation (x-ray and MRI) by an Orthopaedic specialist.

Depending on the age and activity level of the individual there may be the possibility for conservative management as opposed to surgical management.

Returning to sport and activities of daily life is varied from patient to patient. For the general population it usually takes around 12 months to return to sports that require the change of direction.  In some cases the prognosis is more optimistic with recovery being much shorter (6-9 months).

How Physio Helps

If your physiotherapist is the first person to see you post-injury they will take a thorough history of how the injury happened, and then assess your knee.

However, it must be noted that due to the massive amount of swelling which usually takes place following ACL rupture, it is very difficult to accurately assess the integrity of the ACL 1-2 days after injury.  Accurate manual assessment needs to be done immediately post injury or later once the swelling has gone down.  Based on your injury history and best possible assessment of the integrity of the ACL and other structures they should be able to diagnose the degree of damage.

Prior to most surgical treatment it is advised a period of conservative physiotherapy is undertaken to reduce swelling, restore the knee joints range of motion, and build muscle bulk to help stabilize the joint. This is called ‘pre-rehabilitation’.

After the operation, physiotherapy recommences to overcome the effects of surgery, such as swelling, pain and loss of movement.

This knee injury is seen frequently by Physiotherapists and many orthopedic surgeons refer patients to the clinic for the knee rehabilitation.

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