ACL Ruptures: How it Happens and What You Can Do

Here at ESPR Physiotherapy, we treat a lot of ACL injuries especially returning to soccer season. However, it doesn’t only happen in in soccer. Any sport or activity that requires fast direction changes, jumping, landing, cutting, twisting, starting and stopping has a potential for ACL injuries. 

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What is the ACL?

The ACL is a ligament that sits inside the knee between your thigh bone (femur) and shin bone (tibia). This ligament limits excessive rotation of the tibia and femur and stops your tibia from shifting too far forward from your femur. It is a key ligament that keeps your knee stable. 

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How do ACL injuries happen?

These injuries typically happen when your knee goes into a hyperextended position or excessively rotated position for example when it buckles inwards during landing. A major modifiable risk factor for ACL injuries is poor knee control and biomechanics. What that means is your knee’s ability to keep a straight alignment when moving in a static (e.g. single leg squat) and dynamic position (playing soccer).

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What should I do?

After an ACL injury there are two treatment options: high quality rehabilitation alone or ACL reconstruction surgery together with high quality rehabilitation. Rehabilitation is similar for both options of treatment and lasts for about 6-9 months. In fact, the highest risk of re-injury is within the first 12 months of injury/operation. The rehab process is based on milestones rather than timeframe as shown below:

Phase 1 – Reduce swelling and regain movement 

• Reduce swelling and pain which can be done by applying ice 
• Regain full knee extension and be able to bend your knee to 120 degrees
• Be able to stand on the injured leg with the knee slightly bent 

Phase 2 – Regain full movement and have good static knee control 

• Regain full bending and straightening of the knee 
• Be able to do a single leg squat with good knee control – knee cap in line with second toe and not tracking inwards past it. 
• Be able to jog for 10 min without the knee swelling up after the jog 

Phase 3 – Have good dynamic knee control and introduce return to sport 

• Introduce to sport-specific training without pain and swelling
• Single-leg hop tests >90% of good side
• Understand good and bad positions for the knee and be mentally ready to return to sport 

Phase 4 – Return to sport 

• Return to training and games 
• Apply injury prevention program for the knee