Anterior cruciate ligament (ACL) injuries are extremely common in sport, with injury rates increasing over the last decade particularly in AFL, rugby, soccer, and netball. These sports involve cutting, pivoting, and jumping which place high demands on knee stability. Traditionally, ACL reconstruction (ACL-R) has been considered the gold standard for management although emerging evidence is beginning to challenge this notion. However, the challenge remains in deciphering who will have a successful outcome with conservative management versus who is likely to benefit more from ACL-R.
While ACL-R remains the preferred option for many high-performance athletes, non-surgical management may be suitable for individuals who:
· Have a partial ACL tear with minimal instability.
· Have an isolated ACL tear with no associated meniscal or cartilage damage.
· Are willing to commit to a structured rehab program.
Recent research has highlighted the potential for ACL healing without surgery. A study by Filbay et al. (2019) found that individuals who followed a tailored rehabilitation program achieved similar long-term outcomes in knee function, pain, and quality of life compared to those who underwent ACL-R. Additionally, a systematic review by Monk et al. (2022) reported that up to 50% of ACL ruptures can heal given an appropriate amount of time in conjunction with appropriate exercise rehab.
A structured, evidence-based program is essential for successful operative and non-operative ACL management. Below is an example of how a return to play regimen may be designed and applied to an individual or athlete with an ACL injury. What is important to note is that progression between phases and the steps required to return to sport/play is primarily criteria driven. Both physical and psychological criteria milestones must be achieved and met for a successful return to sport mitigating re-injury risk as much as possible.
Goals: Reduce swelling, restore range of motion, and activate quadriceps.
Goals: Improve overall low body strength, control, and proprioception.
Goals: Gradual return to running and cutting drills.
Goals: Full integration into training and match play.
Research has shown comparable long-term outcomes between surgical and non-operative approaches in carefully selected individuals. A recent review by van Meer et al. (2020) found no significant differences in knee osteoarthritis rates between those who had ACL-R and those who opted for a structured rehab program. However, a key consideration is re-injury risk, which remains higher in conservatively managed athletes returning to high-impact sports vs those who have undergone repair.
At CSSM, we offer evidence-based ACL programs tailored to your sport and activity level. Whether you’re aiming to return to competitive sport or simply regain full knee function for everyday life, we provide comprehensive assessments, structured rehab protocols, and return-to-sport testing to ensure the best possible outcome.
Book a CSSM session.
CSSM Physiotherapist Peter Stath relishes the opportunity to help his clients return to the things that mean the most to them, whether that’s sport, work or family. “A strong and healthy body maintains a healthy mind, which allows us to perform and work to the best of our ability.”
Peter promotes an active approach to rehab and has a passion for treating sports injuries such as new and recurrent muscle strains and injuries of the shoulders, hips, knees and ankles.
With a unique understanding of the demands of high level competition, Peter has worked with Melbourne Victory FC Academy as well as with the A League Men’s team. He is currently the Head Physiotherapist for Bentleigh Greens Soccer Club in the National Premier League Victoria competition and also part of the Football Victoria program as a physiotherapist for their state and representative teams.
Peter is also a great advocate for the involvement of children and adolescents in sport, helping them develop healthy habits as they grow. He has a particular clinical interest in working with adolescent athletes.
Peter has valuable experience in pre- and post-operative care and has developed expertise in using Clinical Pilates to facilitate optimal recovery and performance.
Whether it’s an acute injury or simply wanting to optimise performance, Peter has the expertise to diagnose and prescribe a program to get you back on track to achieving your goals. His unique combination of physiotherapy and high level coaching skills is a valuable asset in both the prevention and rehabilitation of injury – particularly in the areas of sports performance in the younger athlete.
Ardern, C. L., Taylor, N. F., Feller, J. A., & Webster, K. E. (2013). A systematic review of the psychological factors associated with returning to sport following injury. British Journal of Sports Medicine, 47(17), 1120-1126. https://doi.org/10.1136/bjsports-2012-091203
Filbay, S. R., Grindem, H., & Roos, E. M. (2019). Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Practice & Research Clinical Rheumatology, 33(1), 33-47. https://doi.org/10.1016/j.berh.2019.01.018
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce re-injury risk by 84% after ACL reconstruction: The Delaware-Oslo ACL cohort study. British Journal of Sports Medicine, 50(13), 804-808. https://doi.org/10.1136/bjsports-2016-096031
Monk, A. P., Davies, L. J., Hopewell, S., Harris, K., Beard, D. J., & Price, A. J. (2022). Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database of Systematic Reviews, 2022(2), CD013257. https://doi.org/10.1002/14651858.CD013257.pub2
van Meer, B. L., Meuffels, D. E., Vissers, M. M., Bierma-Zeinstra, S. M. A., & Reijman, M. (2020). Knee osteoarthritis following anterior cruciate ligament rupture: A systematic review and meta-analysis. British Journal of Sports Medicine, 54(10), 591-597. https://doi.org/10.1136/bjsports-2018-100166
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