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Anterior Cruciate Ligament (ACL) Injury

Home / Conditions / Anterior Cruciate Ligament (ACL) Injury

a patient with pain from a sports injury


The anterior cruciate ligament (ACL) is a band of dense connective tissue which goes from the thigh bone to the shin bone. The ACL is a key structure in the knee joint, as it resists the shin bone moving forwards and rotating. It does this by having immense tensile strength and having lots of receptors in it telling the muscles to hold the knee in place.

Signs & Symptoms

  • Immediate pain in the affected knee.
  • An audible ‘pop’ and ‘snap’ may occur.
  • The knee will become swollen, red and hot to touch.
  • Your knee may feel unstable and lose its full range of movement, causing you to limp.
  • Difficulty performing certain movements, such as turning on the spot. Some sports may not be possible to play.


Knee injuries can occur during sports such as skiing, tennis, squash, football and rugby. You can tear your ACL if your lower leg is excessively forced forwards and if your knee and lower leg are twisted.


Common causes of an ACL injury include: landing incorrectly from a jump; stopping suddenly; changing direction suddenly; having a collision; such as during a football tackle.


ACL injuries are one of the most common types of knee injuries, accounting for around 40% of all sports injuries.

Assessment & Diagnosis

Your specialist Physiotherapist will take a comprehensive history of your injury and symptoms followed by a thorough physical assessment to provide you with a fast and accurate diagnosis. With a diagnosis in place, there will be a discussion regarding the most appropriate treatment and you will be given advice and education to help you make an informed decision on how to manage going forward. Your Physio will like to ask about your usual activities so they can understand your limitations and will work with you to develop a set of personalised goals. You will be regularly assessed so progress can be monitored and for any changes in your treatment to be made.


In more acute conditions where symptoms are irritable, your Physiotherapist may recommend some strategies to reduce symptom severity such as anti-inflammatory medication and the implementation of the RICE protocol – [relative] rest, ice, compression and elevation.


Physiotherapy will help you regain and optimise movement, strength and stability in your knee. Optimising the muscle strength will help to ensure a more successful outcome regardless of whether surgery is decided upon or not. Good rehabilitation may provide the knee with sufficient strength and stability so that surgery is not necessary.


Low-impact exercises, such as cycling will improve your muscle strength without placing too much weight on your knee. You should avoid any sports or activities that involve twisting, turning or jumping until you are confident and competent. All our Physiotherapists at Pure are highly skilled in providing complimentary hands on treatment and will work with you to develop a personalised treatment plan to help you recover and return to the activities which are important to you. You will be supported throughout your recovery with ongoing advice.

Escalation of Treatment

The decision to have knee surgery will depend on the extent of damage to your ACL and whether it’s affecting your quality of life. If strengthening and healing means your knee does not feel unstable or you do not have an active lifestyle, you may decide not to have ACL surgery.


Before having knee surgery, you may need to wait for any swelling to go down and for the full range of movement to return to your knee. Also, it is beneficial to strengthen the whole body with focus on the muscles at the front of your thigh (quadriceps) and back of your thigh (hamstrings) as much as possible to help optimise outcome.

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