Meredith Pfohl 
ACL (Anterior Cruciate Ligament) injuries are fairly common in both the sporting and general population. The ACL is one of the main stabilising ligaments of the knee and helps to control movement of the shin bone relative to the thigh bone. The ACL also has a role in joint position sense – letting our brain know where our knee is in space.
ACL tears can occur by contact (force applied directly to the knee), but most often occur during a rapid change in direction or when landing from a jump (non-contact mechanism). This is common in sports with lots of jumping and agility, such as netball, soccer, basketball and football.
In Australia, ACL injuries have traditionally been managed by surgical repair (ACL reconstruction surgery). However, over the past 25 years, there has been a growing body of research that now shows not all people with an ACL injury require surgical reconstruction. The research quite clearly shows that the outcomes between surgical and conservative management are equal (at a population level) across all outcome measures, including return to sport, knee related quality of life, and future development of knee osteoarthritis. That being said, not everyone does well with conservative management alone. Some people may have repeated bouts of instability (the knee giving way) and may require an ACL reconstruction to regain adequate function.
So how do you know if you should opt for conservative management (exercise based rehabilitation) or surgery (reconstruction followed by exercise based rehabilitation)? Current best practice guidelines recommend a trail of conservative management after the initial injury. This involves targeted exercises to restore knee strength, range of motion, balance, control and correct any suboptimal movement patterns that may be associated with a higher risk of re-injury. If this restores full function and enables a return to sport at the desired level, then surgery is not required. If during the conservative management period the patient experiences ongoing instability and episodes of the knee giving way, then surgery should be considered. Following surgery, the same process of exercise based rehabilitation is required to restore knee strength, range of motion, balance, control and correct any suboptimal movement patterns that may be associated with a higher risk of re-injury.
If you have injured your ACL, our experienced physiotherapists are here to help you on the road to recovery.
