Recovering from an ACL injury can be daunting, but with the right plan, our patients can rebuild strength, regain confidence, and return to the activities they love. A structured, criteria-based approach is essential not just for recovery but for reducing re-injury risk and achieving long-term success.
Here’s the criteria based approach we use to guide our patients:
Acute Phase The focus is on reducing pain (≤3/10 on VAS), managing swelling, and restoring full knee extension. Early progress in these areas is crucial for setting the foundation for later phases. Key methods: neuromuscular stimulation, passive/active extension exercises, and gait re-education drills.
Early Rehabilitation This phase targets movement and endurance. Goals include achieving 120° of knee flexion and improving muscular control with exercises like leg presses and single-leg squats. Building strength here supports long-term stability.
Strength & Control We move into heavier strength training, focusing on 2–4 sets of 8–10 reps at 60–80% of one-rep max. Controlled jumping and landing drills (e.g., sub-maximal bilateral landings) are introduced to prepare for higher-intensity demands.
Advanced Plyometrics Single-leg plyometric training and advanced strength work dominate this phase. We aim for functional goals like an 80% limb symmetry index or 1.5× body weight on leg presses. This phase is about translating strength into power and functional movement.
Return to Sport Here, sports-specific training and multidirectional movements take priority. A safe return to play requires not only physical readiness but psychological confidence, assessed through validated tools and a multidisciplinary team (MDT) approach.
Why This Approach Works:
Recent research highlights the effectiveness of criteria-based protocols:
- Tailored Programs: Improve outcomes and reduce re-injury rates, ensuring progress at each phase of recovery (Griffin et al., 2020; Hewett et al., 2019).
- Strength and Neuromuscular Control: Critical for knee stability, reducing risks of compensatory injuries and re-injury (Krebs et al., 2021).
- Psychological Readiness: Athletes report higher confidence and readiness to return to sport when mental readiness is prioritised (Fitzgerald et al., 2020).
Conclusion:
Recovering from an ACL injury isn’t just about regaining movement it’s about returning stronger and more prepared for the challenges ahead. A criteria-based approach ensures that every phase of rehabilitation has clear goals tailored to each athlete’s unique needs.
References:
- Fitzgerald, G.K., Paterno, M.V., and Myer, G.D. (2020). Psychological readiness to return to sport after ACL reconstruction: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 50(10), pp. 558–566.
- Griffin, L.Y., Albohm, M.J., and Arendt, E.A. (2020). Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the literature. Sports Health, 12(3), pp. 240–246.
- Hewett, T.E., Myer, G.D., and Ford, K.R. (2019). Preventing knee injuries in athletes: An evidence-based approach to training. Clinical Sports Medicine, 38(1), pp. 1–24.
- Järvinen, T.A.H., Järvinen, T.L.N., and Kalimo, H. (2021). Rehabilitation of the anterior cruciate ligament: A review. Sports Medicine, 51(3), pp. 447–461.
- Krebs, A., Naal, F.D., and Maffulli, N. (2021). The role of structured rehabilitation in the management of anterior cruciate ligament injury: A systematic review. British Journal of Sports Medicine, 55(12), pp. 684–690