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The Dreaded ACL Injury – What Comes Next?

Updated: Jun 20

Sporting knee injury, torn ACL
Knee Injury, ACL

You have been playing sport and slipped and suddenly your knee has fallen inwards, and you’ve collapsed to the ground. There’s pain all over your knee and it starts to swell. You’re barely able to put weight through it. In the moment it is hard to know what to do. My suggestion is to contact Hybrid Health Physiotherapy and get on top of it ASAP.

Physiotherapy Bath consultation
Physio consultation

At your initial appointment, there are telltale signs that we will listen and look for, that suggest an ACL injury

  • A non-contact, knee buckling or giving way sensation

  • Immediate non-specific knee pain 

  • Generalised knee swelling within the next 2 hours

  • General sensitivity to touch around the knee

  • Joint swelling

  • Laxity of the Lachman’s or pivot shift knee test

We will need an MRI to 100% confirm the diagnosis of an ACL rupture, and sometimes you can get unlucky and injure other structures of your knee as well. But MRIs take time to get access to, it could be 6 weeks or more! So, what does that mean for you?

Let’s dive into what comes next

Knee Anatomy
The Knee Anatomy

The ACL is one of the main stability ligaments of the knee, which attaches the back of the femur (thigh bone) to the top and front of the tibia (shin bone). Many people have heard horror stories of how once, someone they knew, injured their ACL, and their life completely changed, but that doesn’t have to be the case. The scary news of surgery and 9-12 months of rehabilitation can be daunting, but here at Hybrid Health, it is our job to be your biggest supporter and guide you through this time, with education and progressive strengthening at the centre of your journey.

Like many things, the sooner you can start your rehab, the better your chances are of a full recovery. Even in the first 3 days of injuring your knee, there is a lot we can help you do! The first 1-2 weeks are about getting a “quiet knee” with good movement, reduced swelling, and maintenance of muscle strength, especially in the front thigh muscles, the quadriceps. From here we would look to get your knee as strong as possible while we await confirmation of your MRI and the results.

Some of you may be thinking, what is the point of all this rehab before I know my diagnosis? If I have ruptured my ACL, I’ll need surgery then I’ll have to start all over again! This is not always the case. 

It has been shown that a conservative rehab approach can help people regain their previous levels of function and have just as good long-term outcomes as surgery does. And if you do decide to have surgery, your outcomes are more likely to be positive if you have a strong and quiet knee prior to surgery. The important thing is that you are the primary decision maker of what happens next, and you get all the information you need to make a decision you are pleased with. This means understanding what your rehab plan involves such as:

  • The level of activity/performance you would like to return to

  • The milestones you will need to achieve before continuing onto each phase of rehab

  • Strength

  • Running

  • Plyometrics

  • Return to training (low level sport/activities)

  • Return to play/performance

  • Considering upcoming life events and the time pressure they have on your ability to undergo rehabilitation

Knee ACL Physiotherapy Rehab
Rehab Exercise

So, if you do get unlucky, and you sustain “the dreaded ACL injury” just know that what you do next can massively impact your outcome. Although at the time of injury it can be hard to be optimistic, be proactive and get the help and support you need right from the jump. This way you give yourself the best chance of getting back to your sport or playing worry free with your kids in the garden or travelling around the world carefree. You can say to yourself this injury isn’t the end of my active journey, it’s a speed bump that I will overcome!

Research Articles used to guide this blog

Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Practice & Research Clinical Rheumatology. 2019 Feb 1;33(1):33-47. 

Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative versus conservative treatment of anterior cruciate ligament rupture: a systematic review of functional improvement in adults. Deutsches Ärzteblatt International. 2018 Dec;115(51-52):855.

Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British journal of sports medicine. 2023 May 1;57(9):500-14.

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