March 2nd, 2012

Health N' Sports: ACL Injury and Repair

Staff Report

Health N' Sports: ACL Injury and Repair

Louisville Orthopaedic Clinic shares insight on ACL reconstructive surgery

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation. On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to


Anterior cruciate ligament (ACL) injuries are very common, with as many as 150,000 new tears occurring each year.  These injuries usually occur in sports involving contact, cutting and/or jumping but also can occur in falls or car accidents.  In some instances reconstructive surgery is required to return an individual to their prior level of function, while other individuals choose not to undergo a surgical procedure.  Physical therapy is an integral part of rehabilitating an individual after reconstructive ACL surgery.


The femur (thigh bone) and the tibia (shin bone) meet to form the knee joint.  There are many ligaments serving to stabilize the knee.  The ACL is a ligament in the center of the knee joint which functions to control anterior (forward) movement of the tibia relative to the femur.


ACL injuries occur at times when the ligament is under the most stress.  These injuries commonly occur with sports involving cutting and pivoting with sudden deceleration, such as skiing, soccer, basketball, football, and field hockey. When an individual ruptures an ACL there can be an audible pop, often associated with immediate pain and swelling around the knee joint.  An athletic trainer or doctor can perform manual testing at the site of the injury to assess the laxity of the ligament.  If an ACL tear is suspected the diagnosis can be confirmed with an MRI.  At this point the patient and doctor explore the options of surgical versus non-surgical intervention.  In patients that wish to return to a high level of activity, particularly a sport involving cutting or lateral movement, ACL reconstruction is recommended.


Surgical treatment for ACL tears usually involve arthroscopic reconstruction of the ligament.  A variety of tissues can be used for this procedure.  A common method involves harvesting the central third of the patella tendon, which is located just below the kneecap and attaches to a bony area called the tibial tubercle.  After part of this tendon is harvested, holes are drilled in the femur and the tibia at the attachment sites of the original ligament.  The graft is then pulled through the drill holes and held in place with bioabsorbable or metallic screws.  This is usually an outpatient procedure.  ACL reconstruction surgery is highly successful in returning patients to their desired level of function.  Whether a patient is looking to return to simple activities of daily living or to a high level sport, physical therapy is a crucial part of the rehabilitation process. 


If the patient and physician choose to proceed with surgery, it is helpful to do some preoperative therapy.  The aim is to reduce swelling, maintain or regain full knee range of motion, and to activate the quadriceps muscles as much as possible.  The patient may increase chances of a quicker recovery by working hard on these factors prior to surgery.

Physical therapy is usually initiated within days after surgery to restore range of motion.  The patient may or may not be wearing a protective brace at this point, depending on the surgeon's preference.  The patient will usually be using crutches immediately after surgery, typically bearing as much weight as tolerated unless otherwise specified by the physician.

Weeks 1-2

Reduce inflammation and pain- ice and elevate

Restore the knee's range of motion- at least 100 degrees of knee flexion (out of roughly 135-150 degrees, depending on the individual) and full knee extension (0 degrees)

The hamstrings and calf muscles should be stretched throughout this phase

Contract the quadriceps muscles as much as possible, as these muscles weaken with decreased weight bearing and swelling.

Week 2-6

Patient is likely able to bear full weight

120 degrees of knee flexion should be obtained

Stationary bike to maintain flexibility and conditioning

Strengthening exercises for the quadriceps, hamstrings, and hip musculature are progressed as tolerated

It is also appropriate to initiate some balance training in the early phases, especially for patients returning to sports.

By the end of this stage the patient should have minimal to no swelling or pain

Week 6-12

More difficult exercises will be added to the program to prepare the patient to run

Squats, lunges/walking lunges, single leg press or squats, and eventually single leg hopping

Straight jogging can usually begin at or before week 12 depending on physician preference

In order to progress a running program without pain the patient has to demonstrate good quad and hamstring strength and no effusion.

Week 12 and beyond

More agility work can be performed, including lateral movement such as side shuffling and grapevine, jumping and landing drills, and eventually cutting drills when appropriate. Strengthening exercises should be continued and progressed per individual. The surgeon will always have the final say regarding return to sports, and it may be 6 months or more for a cutting sport

These guidelines are general and are always subject to the surgeon's preferences.  It is extremely important to ensure complete healing of the graft while avoiding a stiff knee, as well as strengthening the appropriate muscles in a safe but challenging manner.  This surgery can be very successful if an individual rehabs appropriately, and collaborated guidance of the surgeon and physical therapist is necessary to this end. 

Reminder: We are still offering the “FREE RUNNING ASSESSMENT”. For details please refer to the article titled “Free Running Assessment” in the archive.

For more information about our practice and providers visit us at

You can also find us on Facebook: Clinic-and-Sports-Rehab-Center-PSC/165958666809221



Recent Articles