What to do if I’ve injured my ACL – your questions answered

by Michael
So…I’m guessing that you have likely suffered an ACL injury. You have likely by now come to the realisation that you may be facing a large stint on the sidelines. 
You have no idea what to expect, you’ve only seen a few snippets of exercises or surgery when an AFL footballer makes his return, and they make a little montage to celebrate. 
You might even be thinking that you won’t be able to get back to sports again. 
The reality is, this is an injury you can absolutely come back from, and one you can thrive with in the presence of fantastic health care (like the team here at pathways physio, of course!). 
But, you probably have a thousand questions and are looking for answers everywhere. 
Maybe you’ve been told by your cousin’s dad’s brother to go do some hydrotherapy. 
Maybe you have been told by your mate’s colleague’s uncle, who knows Chris Judd (because why wouldn’t he?), and Juddy used saunas, so maybe they help ACL injuries. 
All of this is so murky, treacherous and super difficult to navigate. You may feel you need Maverick from Top Gun (topical) or a Hans Solo from Star Wars to pilot this ship and guide you along your journey. 
But, we don’t have Maverick or Hans, so instead I will answer all your frequently asked questions (FAQs). 
So how about it? Let’s get stuck into the nitty gritty. 
We’ll start easy and work our way up! 
I suspect I have an ACL injury …. what should I do? 
First and foremost, stay calm. These are very treatable injuries that you and many other people have, and will recover from. 

Secondly, let’s confirm that it is in fact an ACL injury and try to determine if there are any other injuries to the cartilage or other ligaments that are in the knee. 
A physio is in the box seat to provide a comprehensive examination and give you a better idea of what areas have been affected, following this we will typically send for an MRI scan for confirmation. 
For reference ACL injuries can sometimes be accompanied with medial collateral ligament (MCL) injuries and meniscal injuries, to name just a couple. 
Side note: getting an MRI without any suspicion of injury can be a waste of time, resources and money. An assessment from a physio will mitigate this and determine whether an MRI is actually necessary. 
Why did I suffer an ACL injury?
This is a very difficult question to answer. In short it’s a bit of strength, biomechanics, genetics, psychological, social and probably one of the most neglected things…Luck!
The common mechanism of injury is when your foot is turned out, your knee and hip collapse in, as seen in the image here. Mechanism of ACL injury
Or it can also happen with a hyperextension, or someone taking your legs out. 
Does that position of the knee in the image look or feel familiar?
Will I need a scan to diagnose an ACL injury?
Conformation of an ACL injury via an MRI scan is highly recommended, but only if your physio is suspecting an injury. 
Who is the best person to see when I injury my ACL?
Not just saying this because I am a physio, but a physio is an absolute genuine best first point of contact.
We will comprehensively assess in clinic to understand the underlying mechanisms and barriers to recovery. Most importantly we will get you started on rehab and educate around pathways to return to life, sport or whatever it is that you want to get back to!
ACL injury rehab exercises
For second or third points of contact, we usually recommend going through a GP to get an MRI and then once this is complete, consulting with an orthopedic specialist if you are choosing a surgical route as your recovery (we will get back to this can of worms!) 
Is it safe for me to walk an ACL injury?
Yep! Walking on an isolated ACL injury is safe and in fact can help with the recovery process. 
Do I need a brace or crutches when I injure my ACL?
Potentially, this is more determined by your ability. 
If you feel very weak and painful on that knee, or have a meniscus injury to accompany that delightful ACL injury (because why not do a few extra injuries whilst you’re there right?) then crutches or a brace can be a good tool in the SHORT term. 

Emphasis on the SHORT. 
If you get an ACL repair, most surgeons will not brace, but usually will provide crutches for the first 1-3 weeks. 
Knee Brace for ACL injuries
If you are going the nonoperative rainbow road, we brace depending on symptoms, with a heavy bias towards no brace. It usually just slows your recovery down. 
Can the ACL heal without surgery?
Ding ding ding! You bet it can! 
Again, that doesn’t mean that nonoperative management is for everyone. You need to have a detailed consultation with an appropriate health professional…Like a physio! (have I shamelessly plugged us enough yet?)
MRI revealing ACL healing
But do I (as in you the reader) need surgery? 
Ooh, I see you like opening cans of worms. 
This is a very in depth question that will revolve around a number of things: 
One, the goals of the person. 
Two, the age of the person. 
Three, will you or this person want to return to jumping and change of direction sport. 
Four, are there time restrictions for return to said activities. 
Five, have all the pros and cons of surgery vs no surgery been laid out. 
The key thing to note is that we are seeing and hearing emerging evidence that surgery is not always necessary to return to sport and life. 
In summary, a non-surgical option is exactly that, an option. 
On another big note to make, and a conversation I have all too often is:
“Well my favourite AFL player had surgery to repair it, so shouldn’t I?”. 
Aussie Rules footballer Chris Judd injures his ACL
This is a bit like asking if you should be training as often as an AFL player, or if you should have the same pay check as an AFL player. 
It is completely context specific. AFL players have certain time constraints, contractual requirements, and access to a wide array of medical services. 
Lots of their choices are based on those specific things, as opposed to someone who wants to get back to running, and whose livelihood is not dependent completely on chasing a football in a big grass paddock. 
How long is the rehab for an ACL injury? 
For surgically repaired ACL’s it’s around 12 months from date of surgery to return to competitive cutting and jumping sports. We also to have to respect the surgeons orders which can vary depending on the method of surgery. 
For nonoperative ACL’s it can be between 5-9 months from the first date of rehab to these aforementioned sports. Best part is we get to be cowboys (grab your hat), no need to be tethered to surgeon orders, we progress through our criteria at our unique pace. 
What does the rehab for an ACL injury look like? 
To provide a broad overview of the rehab, we can look at five main things (not always executed in this particular order, we do see overlap): 
1 Get your swelling down and get your full movement back in the knee 
2 Strengthen the absolute heck out of your muscles which support the knee (QUADS are king) 
3 Back into the running!
4 Get your balance and jumping back, in a progressive and detailed way. 
5 Return to sport or activity gradually. 
Plyometric exercise for an ACL injury
Will I get back to running after an ACL injury?
Absolutely, you can! Step 3 above in the broad overview has hopefully confirmed this. 
Typically for my surgical people, most people will be back to running around the 3-4 month mark, but it is heavily predicated on ticking off key criteria. 
For the nonoperative legends, it can be within 1-3 months, and it is more heavily determined by criteria as opposed to just time. 
Will I be able to get back to playing sport following an ACL injury? 
Optimist Mike to the rescue again. 
Of course you can. 
BUT, you need to complete a great rehab and understand that it’s more than just the work you put in during the rehab. It is also super crucial to maintain all the wonderful benefits that you have earned during the rehab process once you have returned to sport. 
What are the chances that I may injure my ACL again?   Should I be concerned? 
There is always an increased chance of reinjury when you have previously experienced one of these injuries. 
Unfortunately, we can’t get our DeLorean out and contact the Doc to take us back in time. 
We have something better though. Wondering what it is? 
You guessed it! A robust, comprehensive and respectful rehab program. With ongoing maintenance. 
I chose the word “respectful” very deliberately. We respect the role of time in healing, we respect the need for criteria to be met before progressing, and overall we respect the consistency needed for this type of rehab. 
P.s: If you don’t know what the DeLorean is or who “the doc” is, get googling, or ask your parents! 
Michael is a Physiotherapist at Pathways Physiotherapy in Ferntree Gully who specialises in ACL Rehabilitation. BOOK AN APPOINTMENT to see Michael.
ACL Rehabilitation Exercise