ACL Reconstruction
Safe return to sport after ACL reconstruction
What is this surgery?
The anterior cruciate ligament (ACL) is one of the knee's main stabilisers. When ruptured — often during direction changes, jumps, or contact sports — the ligament is surgically reconstructed using a graft (hamstrings or patellar tendon). ACL reconstruction is a demanding procedure requiring 6–9 months of rehabilitation. Statistically, 1 in 3 patients without adequate rehab injures the other knee within 5 years.
Why is rehabilitation essential?
- Repaired graft needs time to integrate (ligamentisation 9–12 months)
- Restore neuromuscular control and proprioception
- Correct muscle imbalances (hamstrings/quadriceps ratio)
- Validate return-to-sport criteria (strength, stability, psychology)
- Reduce re-rupture risk from 25% without protocol to under 5%
Treatment objectives
- Symmetrical muscle strength in both legs (>90% symmetry)
- Full knee stability during direction changes
- Single-leg hop test: >90% symmetry
- Pain-free running and jumping
- Psychological readiness for return to sport
What to expect?
Weeks 1–3: Inflammatory Phase
Swelling and pain are normal. The goal is full knee extension (0°) and quadriceps activation. You'll walk with or without crutches depending on the surgeon's protocol. Physiotherapy begins immediately.
Weeks 4–12: Building Phase
The graft is in its weakest phase (ligamentisation process). Strengthening, proprioception and controlled loading are the focus. Running is possible from week 12 (straight lines). BFR training is used to accelerate muscle development.
Months 4–9: Return-to-Sport Phase
Direction changes, jumping, and sport-specific training. Regular tests (strength, hop-tests) determine clearance. Psychological preparation is as important as physical at this stage.
Our treatment programme
Phase 1 — Weeks 1–3
- Pain & swelling management
- Restore full knee extension
- Quadriceps activation (EMS optional)
- Walking without aids
Phase 2 — Weeks 4–9
- Strengthening: squat, leg press, step-up
- Neuromuscular training & proprioception
- Running (straight line from week 12)
- Blood Flow Restriction (BFR) training
Phase 3 — Week 10+
- Direction changes & jumps
- Sport-specific exercises
- Return-to-sport tests (single-leg hop, KTS)
- Psychological return-to-sport preparation
Risks without structured rehabilitation
- Re-rupture risk up to 25% without structured protocol
- Chronic instability and early arthritis
- Compensatory injuries to the other knee or hip
- Psychological barriers ('fear of re-injury')
Ready for your rehabilitation?
Book an initial assessment — we create your personalised programme.