Current Trends – Anterior Cruciate Ligament (ACL) injury management

by Ingrid Davis – Club 360 physiotherapist

ACL injury management is always a hot topic and an area of much research & treatment innovation, particularly in my home country of Australia where we have some of the highest rates of knee injury in the world, due to our sporting culture and the dominance of Australian rules football (AFL), netball and rugby.

Often, clients in Tokyo ask our advice about management of knee ligament injuries, and I hope in this article to outline the current thoughts in this area.

Surgery vs non-operative rehabilitation

The current trend is toward conservative management and exercise therapy whenever possible. Clinically, conservative care seems to be effective especially in cases where the individual is not competing in high-level sports, has no persistent mechanical locking or instability of the knee, and is not planning to be involved in demanding sports in the future.

There is a large body of research reporting a similar outcome in long-term measures of function, pain, early arthritis and return to sport in both the reconstructed and non-reconstructed groups. If, however, you hope to play competitive sports like rugby or AFL, it is likely you would need to reconstruct the ligament to ensure sufficient joint stability.

Rehabilitation – a longer outlook.

Until recently the focus of ACL rehab, with or without surgery, has been on a successful return to sport. Usually we manage the patient for 12 – 18 months to achieve this aim then they are out the door. Often there is no follow-up after the client reaches this goal, yet research indicates that there is a need for further monitoring in both groups.

Unfortunately, in both reconstructed and non-surgical individuals there is a higher rate of early knee joint degeneration/arthritic changes. This is thought to be due to cartilage and joint damage sustained at the time of the initial injury, plus the impact of altered joint mechanics after ligament deficit or reconstruction, may play a role over time. There is a high re-injury rate, even after surgery, if the clients do not continue to monitor/retain strength & agility. A physiotherapist is able to offer advice on suitable levels of sports participation and exercise to avoid re-injury.
Annual check up after return to sport

Current research suggests a longer-term view of ACL management. Perhaps an annual check-up, just like going to the dentist, to ensure your ongoing exercise programme is ideal for maintaining strength, preventing recurrence of injury, and lessening the risks of early arthritic changes in the knee.

For further advice regarding this, or other injury management, contact one of our physiotherapists at