ACL Tears: The Latest Scoop

Date Published

May 2, 2024


Rachael Simpson


An anterior cruciate ligament (ACL) tear can be a daunting diagnosis, often conjuring images of surgery and lengthy recovery times. However, not all ACL tears require surgical intervention. Non-operative (conservative) management, particularly through physiotherapy, has gained prominence as an effective approach in recent years. In this guide, we delve into the realm of non-operative ACL tear physiotherapy management, exploring its principles, goals, and outcomes according to the latest evidence. 

What is the ACL?

The ACL is one of the ligaments in the knee that connects the femur (thigh bone) to the tibia (shin bone). Its main role is to stabilise the knee by preventing excessive sliding and rotation of the joint. Ligaments connect bone to bone, and have an important role in proprioception (joint movement and position sense).

A Shift in Perspective

When an individual sustains an ACL tear, they’re often presented with two options: surgical reconstruction or non-operative management through physiotherapy. Traditionally, we’ve been told that once the ACL tears, it’s gone. However, studies over the last few years show evidence of ACL healing with conservative management, seen on magnetic resonance imaging (MRI) (Filbay et al, 2023; Pitsillides et al, 2021). Typically, patients who undergo conservative management progress faster in their rehab journey as they do not have to recover from the effects of surgery, such as increased pain and swelling.

Goals of Conservative Management

Physiotherapy is a major component in the non-operative management of ACL tears. Its primary goals include:

  • Restoring joint range of motion: After an ACL tear, the knee joint often experiences restricted range of motion due to pain, swelling, and muscle guarding. Physiotherapy interventions aim to alleviate these issues and restore the knee’s full range of motion. Some conservative methods see patients in a motion limited brace for a period of weeks during the early stages of rehab – this is called Cross Bracing Protocol
  • Muscle strengthening: Strengthening the muscles around the knee, particularly the quadriceps, hamstrings, and calf muscles, is crucial for providing stability and support to the injured joint. Physiotherapy exercises focus on improving muscle strength, endurance, and coordination
  • Improving proprioception and balance: ACL tears can disrupt proprioceptive feedback and balance, increasing the risk of re-injury. Physiotherapy incorporates exercises that challenge proprioception and improve balance, reducing the likelihood of instability and re-injury
  • Functional Rehabilitation: Ultimately, the goal of physiotherapy is to facilitate the individual’s return to their desired level of activity and function. This involves a progressive rehabilitation program tailored to the individual’s specific needs, considering factors such as age, activity level, and sporting/work requirements

Outcomes and Expectations

The outcomes of non-operative ACL tear physiotherapy management vary depending on various factors, including the severity of the injury, if other structures are injured too, individual compliance with the rehabilitation program, and adherence to activity modifications. In one study, 90% of patients with a complete rupture of the ACL showed evidence of healing on a 3 month MRI after following the Cross Bracing Protocol. Patient-reported outcomes are very important to consider; if someone does not feel satisfied with their knee after conservative management, they are still able to then undergo surgery. There are no drawbacks from having surgery later, other than the additional time for rehab afterwards.

It’s essential for individuals undergoing non-operative management of ACL tears to actively participate in their individualised rehabilitation program to optimise outcomes and minimise the risk of complications. ACL rehab is a lengthy process, regardless of surgical intervention or conservative management. However, conservative management allows patients to avoid potential complications that can arise from an invasive surgery, often allowing rehab to commence sooner after injury. 


Non-operative management through physiotherapy offers a viable alternative for certain individuals with ACL tears, providing effective rehabilitation, restoration of function, and reducing the risk of re-injury. By understanding the principles, techniques, and outcomes of physiotherapy management, individuals can make informed decisions regarding their treatment options and embark on a path towards recovery and restored function. If you are weighing up your options after an ACL tear, is a wonderful site to visit for more information.