ACL Timelines

How Lach works with his clients to return to sport

ACL injuries are common in young populations playing in multi-directional sports (think netball, touch football, AFL, soccer etc.) Often it is common to feel angry, upset and uncertain about future sporting endeavours with this injury, as it is associated with a significant amount of rehabilitation post surgery. While timelines can vary pending other obstacles such as additional meniscus or MCL/LCL injury, return to sport generally occurs within 9-12 months post surgery. This is a similar timeline to if conservative management was to be completed instead. 

While timelines are good at helping to motivate people to continue rehab diligently, I have found in my experience that it can also be detrimental to the rehab process. With most of my ACL population ranging from 14-25 years of age, I find that focusing on timelines only can lead to patients rushing their rehab and skipping fundamental steps that are essential in returning to sport safely with minimal risk of re-rupture. For example, some patients may be unable to perform a squat with appropriate alignment at 3 months, yet they will return to running because they read online that most people are running at this stage. While I personally have not experienced any, most re-ruptures that occur prior to the return to sport stage is when the patient is progressing too quickly and are attempting something that their knee is not yet ready to handle.


With that in mind, I find it essential to use a functional goals protocol throughout the rehabilitation journey. Instead of pressuring the patient to achieve a certain goal by a certain amount of time, I simply do not progress them further until they achieve said goal. A great example that I use frequently is the Melbourne ACL Rehabilitation Guide 2.0 by Randall Cooper and Mick Hughes. This guide breaks down step by step what the patient should be able to achieve prior to progressing to the next phase. From phase 1 (recovery from surgery) to phase 4 (return to sport), this guide allows the patient and treating clinician to safely progress their rehabilitation. For example, if one of my patient’s is in stage 2 and is keen to start running/plyometrics because they are at the feeling confident they can achieve this, I will get them to complete certain tests in the protocol. If they pass all of the tests I will begin the progress into stage 3. However, if missing only one I will still keep them in stage 2 until that said test is passed. Usually from stage 1 to stage 4 does take 9-12 months, however if they fail their return to sport testing at the 12 month mark, I will advise that they not return and continue rehabbing until they clear said testing.
To be clear, it is still essential to explain to all ACL patients that the rehab process is long and does generally take 9-12 months pending progress post surgery. However, it is key that functional goals are met consistently throughout this timeline, as rushing through rehab and going solely on timelines can increase the risk of re-rupture to the ACL. 

Lachlan Knuth – Physiotherapist

Scroll to Top