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What is the ACL? Why is it so commonly injured?

The anterior cruciate ligament or ACL is located in your knee. It prevents tibia from anteriorly shifting past the femur and allows for rotational stability. It‘s main function is to stabilize the knee joint


How is the ACL injured?

The ACL is most commonly injured when someone makes a sudden stop and changes direction, like a cutting motion. This is often seen in sports like basketball, soccer, and football. The ACL prevents the tibia from shifting anteriorly and provides rotationally stability of the knee. Combined motions of stopping and turning are the perfect combination to tear or injure the ACL.


What does recovery look like?

Recovery/rehab for ACL reconstruction should take at least 9 months. If you go back any sooner then the 9 month mark, you are 7 times more likely to injury your ACL again. Many athletes wish to return sooner because of the long and tedious recovery. Depending on your sport your recovery may look different. If your sport requires pivoting and sudden stop you will need to make a full recovery with specific training. During this rehab there are specific criteria you need to fulfill to stay on track and progress.

Phase 1: Immediate Post-Op (0-2 weeks after surgery)

-Knee extension with range of motion 0 degrees -Quad contraction with superior patella movement and full active extension -Straight leg raise without lag

Phase 2: Intermediate Post-Op (3-5 weeks after surgery)

-No swelling -Flexion with range of motion within 10 degrees -Extension with range of motion equal

Phase 3: Late Post-Op (6-8 weeks after surgery)

-No excess fluid in knee joint/swelling/pain after exercise -Walking normal -Range of motion is equal -Symmetrical joint position

Phase 4: Transitional (9-12 weeks after surgery)


-No instability

-Maintain strength in quad

-With 60 degrees of knee flexion do 10 repetitions of single leg squats with proper form

-Drop vertical jump with control

-KOOS-sports questionnaire above 70%

-Isokinetic testing in quads, hamstrings, and glutes >80%

Phase 5: Early Return to Sport (3-5 months after surgery)

-Complete run with pain, fluid building in knee or swelling -Hop testing -66% ratio of hamstrings to glutes -Isokinetic strength testing >90%

Phase 6: Unrestricted return to sport (9+ months after surgery)

-Glute, hamstring, and glutes index >95% for isokinetic testing ->66% ratio of hamstring to glutes -Hop testing >95% -KOOS sport questionnaire >90% -Subjective knee evaluation


What steps can you take to make sure it isn't re-injured?

  1. Do not rush your recovery

  2. Listen and get help from professionals (those who specialize in return to sport rehab)

  3. Continue to train and stay strong


Dr. Claire's Experience with Knee Injury

Dr. Claire played competitive sports her entire life and played basketball at the collegiate level. Unfortunately, Claire suffered multiple knee injuries early on in her career, leading to a total of 4 knee surgeries by the age of 20. She was able to play basketball her senior of high school. However, she worked hard and play 4 years of D1 basketball in college. Today she continues to train so she is strong and healthy to live pain free and do the activities she loves. She continues to rock clim, run trails, compete in triathlons, and play basketball after retirement. Dr. Claire does not believe getting injured should prevent you from doing the things you love.


Dr. Claire became a physical therapist because she wanted to prevent young athletes from experiencing the consistent injuries that left her sidelined for so long. Dr. Claire combines her own experience as an athlete/patient and her doctorate degree and strength and conditioning certification to provide the best return to sport and injury prevention care possible.


How can Perform Physical Therapy help?

Proper return to sport rehab is often the difference between returning to your sport healthy and injury-risk free and potentially re-tearing or injury the other leg. We combine strength and conditioning, plyometrics, and manual therapy to help you return to your sport better than you left it.


With Dr. Claire's experience in her own return to sport rehab, strength and conditioning, and physical therapy she will help you recover so you can get back to your sport and doing the activities you love. One on one sessions with manual therapy and strength training are the best option to get you better faster.



Work Cited:

Rehabilitation Protocol for ACL - Massachusetts General Hospital. https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-acl.pdf.


“Returning to Sports after ACL Surgery.” Returning to Sports After ACL Surgery: Dr. Matthew Pifer: Orthopedic Shoulder Surgeon, https://www.matthewpifermd.com/blog/returning-to-sports-after-acl-surgery.


Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. Susanne Beischer, Linnéa Gustavsson, Eric Hamrin Senorski, Jón Karlsson, Christoffer Thomeé, Kristian Samuelsson, and Roland Thomeé

Journal of Orthopaedic & Sports Physical Therapy202050:2, 83-90



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