ACL tear rehabilitation.
Article by Sydney sports physio, Chris El-Hayek.
As a sports physiotherapist working with athletes of all levels across Sydney, I’ve helped countless patients navigate the difficult journey of ACL injuries and post-surgical recovery. In this article, I’m sharing insights from a recent case involving a 17-year-old female footballer who suffered a full ACL tear requiring reconstruction, to illustrate the importance of personalised, professional treatment in the early stages of ACL rehabilitation.
How the ACL works.
The anterior cruciate ligament (ACL) is a key stabiliser in the knee, allowing athletes to cut, pivot, and land safely. ACL injuries often happen during sports like football, basketball, or netball, particularly through sudden direction changes, awkward landings, or direct collisions. When the ACL is torn, the injury can extend beyond the ligament itself, affecting other knee structures or even nearby joints, as was the case with this athlete, who also sustained a significant ankle injury.
The complexity of this ACL injury.
This patient injured her ACL during a defensive play, when her foot remained planted as her leg rotated forcefully. She experienced a loud pop and immediate pain in the knee and ankle, requiring crutches for mobility. MRI scans confirmed a full-thickness ACL tear, along with additional knee and ankle trauma, including MCL sprain, bone bruising, and a syndesmosis (high ankle) injury—all of which demanded a carefully coordinated treatment plan.
Co-ordinated surgical management.
A tailored approach was essential. Ankle surgery was prioritised first, allowing the athlete’s knee swelling to subside and early mobility work to begin before ACL reconstruction. Spacing out the surgeries reduced both the physical and psychological burden, preparing her body for optimal recovery.
Why professional guidance is important after an ACL injury.
Before surgery, I worked intensively on knee mobility and strength (prehabilitation), always within safe limits. Post-operatively, our focus shifted to carefully guided early rehabilitation, aimed at restoring knee extension and flexion, controlling swelling, regaining a normal walking pattern, and preventing muscle atrophy. Milestones such as gradually weaning off crutches and using advanced modalities like blood flow restriction (BFR) training were achieved only with constant assessment and expert adjustment.
These treatments are highly individualised—what works for one person could cause setbacks or further injury in another. Attempting these exercises without professional oversight can compromise surgical outcomes, increase the risk of re-injury, or even lead to long-term complications.
The path forward for the athlete.
Early progress for this athlete included significant gains in muscle strength, knee range of motion, and confidence walking unaided. But ACL rehabilitation is not a race. Especially for athletes under 18, research shows it is critical to wait at least 12 months before returning to multidirectional sports like football or basketball. Progress should always be criteria-based rather than timeline-driven to minimise the risk of reinjury and ensure long-term joint health.
Don’t risk your recovery after an ACL injury.
ACL injuries are complex and demand a comprehensive, evidence-based rehabilitation program guided by an experienced sports physiotherapist. If you’ve suffered an ACL tear or are concerned about knee instability, don’t leave your recovery to chance.
Book an appointment with me today to start your journey back to sport with the confidence of expert, personalised care.
If you have a sports injury and are looking to have it assessed and/or rehabilitated, contact me today. I will provide an evidence-based approach to managing your condition and getting you back on the field as soon as possible.
Chris El-Hayek
Sports Physiotherapist
“I believe exercise and sport is so important to our physical, social and mental wellbeing. My knowledge and skill set as a sports physiotherapist and strength & conditioning coach has allowed me to help patients achieve their optimal goals and performance” – Chris El-Hayek, Sydney sports physio.