ACL Tears: From Injury to Comeback

A Major Blow for Active People

An ACL tear is one of the most serious injuries in sport. It affects the anterior cruciate ligament, a key stabiliser in the knee. These injuries are especially common in sports that involve cutting, pivoting, or sudden stops, like soccer, basketball, netball, and skiing. In Australia, around 14,000 ACL reconstructions are performed each year — one of the highest rates in the world. The cost to the community is huge: surgery, rehab, time off work or sport, and the long-term risk of knee arthritis later in life.

What Happens When You Tear an ACL?

The ACL is a tough band of tissue that helps keep the knee stable during movement. It connects the thigh bone (femur) to the shin bone (tibia). A tear usually occurs when the knee twists suddenly or lands awkwardly, often without contact. People often describe a “pop”, followed by swelling, pain, and the feeling that the knee might “give way.” Some can walk, but the knee feels unstable, especially when turning or changing direction.

How Is It Treated?

There are two main paths for treatment: surgical reconstruction or non-surgical rehab.

• Surgery is often chosen by younger athletes or people in pivoting sports. It involves replacing the torn ligament with a graft (from the hamstring, patellar tendon, or a donor).
• Non-surgical rehab is suitable for many others, especially those who don’t play high-risk sports. It focuses on building strength, control, and confidence in the knee.

Either way, rehabilitation is essential. A physiotherapy-led program may include:

• Swelling and pain management
• Muscle reactivation and strength building
• Balance and coordination training
• Running, jumping, and sport-specific drills

Recovery time is long — most people return to sport between 9–12 months, and returning too early increases the risk of re-injury.

What’s Less Effective?

Rest alone won’t help — the knee will stay weak and unstable. Braces may provide short-term support, but they can’t replace rehab. There’s limited evidence for treatments like electrical stimulation, laser, or passive stretching as standalone options. Surgery without structured rehab also leads to poor outcomes.

What’s New in ACL Management?

Recent research supports the “prehabilitation” approach — building strength before surgery to speed up post-op recovery. There’s also better understanding of movement patterns that lead to injury, which can be changed through technique training. Some researchers are investigating ACL repair techniques (instead of full reconstruction), and wearable tech is helping monitor progress and return-to-sport readiness.

How to Prevent ACL Injuries

• Use an ACL prevention program (e.g. FIFA 11+ or Netball Knee)
• Warm up properly before sport
• Strengthen your hamstrings, glutes, and core
• Practise safe landing and cutting techniques
• Avoid returning to sport too early after injury