Knee ACL injuries

Of all sporting injuries, a rupture of the anterior cruciate ligament (ACL) of the knee is probably the most notorious. The injury may be preceded by a hard tackle, but is more likely to occur following a routine jump for a catch, or a change of direction while running. As heart-breaking as the injury is, equally frustrating is the length of time required to recover. Traditionally, reconstructive surgery was required, followed by 12 months of rehabilitative exercise and physiotherapy before considering a return to sport. In recent times, patients have sought different types of surgery to reduce the lengthy recovery, as well as a growing movement which proposes conservative exercise therapy with no surgical intervention at all.

Anatomy: Where is the ACL?

Knee ACL injuriesThe ACL is located deep in the knee joint and runs from the base of the thigh bone (femur) to the top of the shin bone (tibia). This ligament is integral to the stability of the knee, preventing the tibia from slipping forward or rotating excessively away from the femur.

Interestingly, women are far more likely, than men, to experience an ACL injury. This is due to:

  • anatomical differences within the knee joint
  • relative dominance of quadriceps muscles compared to hamstrings
  • wider pelvis creating greater inward angle of the femur
  • greater laxity of ligament tissue

Signs & symptoms

knee acl injury physio nedlands, clinical pilates perthOne of the most important signs associated with ACL rupture is the distinct mechanism of injury. The athlete is usually “cutting” or rapidly changing direction with their foot firmly planted. This action produces not only a rotational force at the knee, but also a very strong contraction from the quadriceps muscles as the person quickly decelerates.

Less commonly, the ACL may be ruptured due to impact from an external source, such as a competitor falling into the standing leg.

Apart from this typical mechanism of injury, other signs and symptoms may include:

  • audible “pop” sound at the time
  • knee feels unstable, possibly giving way
  • diffuse swelling around the knee
  • unable to fully straighten the leg
  • pain may range from mild to severe

Your Physiotherapist will use this history, physical tests and imaging results to diagnose an ACL rupture. Additionally, a skilled Physiotherapist will check for damage to other structures which are often associated with ACL injuries.


Following diagnosis, your Physiotherapist will explain the best way to look after your knee in the short-term. This will revolve around the use of ice, rest, compression and gentle movement strategies to reduce swelling and regain pain-free movement of the knee joint.

Physio treatment for ACL rupture:

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  • acute management of swelling and pain
  • gentle range of motion exercises
  • joint mobilisation
  • deep tissue massage
  • safe exercises
  • progressive exercises for strength, control, balance
  • plan for return to sport


Your Physiotherapist will be able to describe the pros and cons of both surgical and non-operative management options. Surgery is generally indicated if the person is young, very active, has multiple structures implicated or has significant joint instability. To achieve the best outcomes it is important to restore as much movement and strength BEFORE surgery, which will make post-operative rehabilitation less arduous.

Alternatively, many people have experienced successful outcomes without undergoing surgery at all, preferring to focus on intensive physiotherapy and specific exercises.

At Wisdom Physio Nedlands, we will support your decisions and guide you through the entire process, from injury to full recovery.