The Role of Physiotherapy in ACL Surgery Recovery: Understanding the Process and Maximising Rehabilitation Outcomes

The Role of Physiotherapy in ACL Surgery Recovery: Understanding the Process and Maximising Rehabilitation Outcomes

Anterior Cruciate Ligament (ACL) injuries are a common concern for athletes and individuals leading active lifestyles. The ACL plays a crucial role in stabilising the knee, and its injury can lead to pain, instability, and a long journey to recovery. Depending on the nature of the ACL injury, two primary surgical options exist: ACL repair and ACL reconstruction. This article aims to demystify these treatments and outline the rehabilitation process to help patients navigate their recovery journey effectively.

ACL Repair: A Closer Look

ACL repair is typically recommended when there is an avulsion injury, where the ACL detaches from either the femur (Type 1) or the tibia (Type 3). During this procedure, a suture is placed on the ligament and drawn through a hole drilled through the bone from which the ligament has detached. An additional suture is fixated through the bone on the opposite end to stabilise the ligament, preventing future detachment.

Rehabilitation Focus: The primary goal in the early phase of rehabilitation after ACL repair is to reduce swelling, improve joint mobility, and maintain muscle tone without putting undue stress on the repaired ligament. Exercises often include gentle range-of-motion activities, isometric strengthening exercises, and careful weight-bearing as tolerated.

ACL Reconstruction: Understanding the Procedure

When the ACL ruptures or tears (Type 2), an ACL reconstruction is advised. This procedure involves replacing the torn ACL with a graft, which can be an allograft (tissue from a donor) or an autograft (tissue from the patient's own body, such as the hamstring or patellar tendon). The tibialis anterior tendon is a common choice for an allograft. Fixation points are established on the outer edges of the femur and tibia to secure the graft.

Rehabilitation Journey: Rehabilitation after ACL reconstruction is a phased approach aimed at restoring knee function, strength, and stability. The initial phase focuses on reducing swelling, achieving full knee extension, and starting gentle range-of-motion exercises. Subsequent phases introduce strengthening exercises, proprioception training, and eventually sport-specific drills. The main goals throughout the rehabilitation process are to protect the graft, gradually increase the knee's functional capacity, and reduce the risk of re-injury.

The Phases of ACL Rehabilitation

Both ACL repair and reconstruction rehabilitation can be divided into several key phases, each with specific goals and exercises:

  1. Early Post-Operative Phase: Key goals include pain and swelling management, restoring full knee extension, and beginning weight-bearing activities as advised. Exercises might include leg lifts, ankle pumps, and gentle stationary biking.

  2. Strengthening Phase: As healing progresses, exercises aim to strengthen the muscles around the knee, including quadriceps, hamstrings, and calves. This phase may include leg presses, hamstring curls, and resistance band exercises.

  3. Functional Training: Focuses on restoring the knee's functional abilities through exercises that mimic daily activities or specific sports movements. This might involve balance exercises, plyometrics, and agility training.

  4. Return to Sport: Tailored to the individual's sport, this phase prepares them for a safe return to sport-specific activities. Exercises are designed to ensure the knee can handle the specific stresses of the sport.

Role of the Physiotherapist

Throughout the rehabilitation process, physiotherapists play a pivotal role. They assess the knee's progress, guiding the patient through each phase based on specific criteria, including pain levels, stability, strength, and range of motion. Progression through the rehabilitation phases is determined by the patient's ability to perform exercises safely and effectively without exacerbating symptoms.


Recovery from ACL surgery is a structured yet individualised journey, requiring patience, diligence, and adherence to a physiotherapist's guidance. Understanding the process, from the initial injury through surgery and rehabilitation, empowers patients to take an active role in their recovery, aiming for the best possible outcome and a safe return to their preferred activities.