Part of ACL reconstruction rehab

An ACL tear without surgery: what rehab can do, and who decides

An ACL tear without surgery is a real option for some people and the wrong one for others, and which group you are in is a judgement your surgeon makes with you rather than one a web page can make for you. Here is what the evidence supports. In a Swedish trial of 121 young, active adults with a fresh ACL tear in a knee that had never been injured before, structured rehab with the option of a reconstruction later gave the same knee scores at 2 years, and again at 5 years, as rehab plus an early operation, and about half of the group offered the delayed route had still not had the operation five years on (Frobell and colleagues, 2010 and 2013). In a UK trial of 316 people whose ACL injury was no longer fresh and whose knee was still unstable, the group assigned to a reconstruction scored better at 18 months than the group assigned to rehab, and 41% of the rehab group went on to have surgery inside those 18 months (Beard and colleagues, 2022). Those two findings are not in conflict, because they describe different knees. A fresh tear in an active person who has not yet done months of loaded rehab is a different question from a knee that has been giving way for a year. There is a limit on how long waiting stays free, though: where an operation is already indicated, the AAOS guideline gives a strong recommendation for early reconstruction, because the risk of further cartilage and meniscus damage starts to increase within 3 months of the injury (Brophy and Lowry, 2023). One thing is not in question either way: the ligament is not expected to knit back together, and OrthoInfo says a torn ACL is generally reconstructed with a graft rather than repaired, because its blood supply is poor and repairs fail often. What rehab is treating is the rest of the knee, the thigh muscle and the control, not the ligament itself. If your knee locks, keeps giving way, or swells up within a few hours of a twist, that is a reason to be seen rather than a reason to keep training, and the warning signs on this page say how fast.

Warning signs, and when to get help

What rehab without ACL surgery actually involves

It is not a lighter version of the surgical program. It is most of the same program without the operation at the front of it, and it runs for months rather than weeks.

It is also not treatment for the ligament. Be clear about that before anything else. A torn ACL is not expected to knit back together, which is why a surgeon reconstructs it with a graft instead of stitching it.

What rehab builds is everything around the ligament: the thigh muscle, the control of the joint, the way the knee behaves under load. Some knees do very well on that. Some do not, and the ones that do not are the ones that keep giving way.

The aims in the first few weeks are the ones every ACL plan starts with, whether or not there is an operation coming: swelling down, a knee that straightens as fully as the other one, and a thigh muscle that switches on again when you ask it to. Quad sets and the straight leg raise are the two that do most of that early work.

Nobody should start down that list on an unassessed knee, and the one legged part is where that matters. If your knee is still locking, giving way, or swelling up within a few hours of ordinary activity, it needs to be examined before anyone loads it on one leg, and the warning signs on this page say how fast and who to go to. Leave the one legged work out until it has been checked. Once it has, do it within reach of something solid, because the knee this page is about is one that can give way without warning. If you have fallen in the past year or feel unsteady, do the standing exercises next to a kitchen counter.

After that it becomes strength and control on one leg, which is where single leg stance and the supported single leg squat come in, and only then running and changing direction.

Dose is set by your own physio or physical therapist rather than by a page. As a rough guide, the early exercises are often done little and often, several short goes a day, and the strength work later moves to 2 or 3 sets of 6 to 15, two or three times a week. Single leg stance is a short hold rather than a long one: a few seconds for each knee lift, building up as your balance improves. Your physio will adjust this to your knee and to what you are training for.

This page is for adults. A child or teenager with a knee injury should be assessed by a doctor or physio before starting any exercise program. If you are pregnant, check with your midwife, doctor or physio before you start.

What makes the difference is supervision, not the exercise list. In both of the trials this page draws on, the rehab arm was a structured, supervised program with a therapist watching the knee and progressing it, not a leaflet.

The UK trial spelled out what its rehab arm had to contain, which not many trials do. Sites had to deliver the program through senior physiotherapists experienced in ACL injury, with a minimum of six sessions over at least 3 months, aimed at controlling pain and swelling, getting the movement back, improving neuromuscular control, getting the muscle strength back, walking normally again and returning to function (Davies and colleagues, 2020). Six appointments spread over 3 months is the floor there, not the plan. If you are weighing up this path, the comparison is surgery against that, and not surgery against doing your best on your own.

What happens if you do not have the operation?

Two good trials have asked it, in two different kinds of knee, and the answers only look contradictory until you read who was in them.

The Swedish trial, usually called KANON, randomized 121 young, active adults, average age 26, with an acute ACL tear in a knee that had not been injured before. Everyone got structured rehab. Of those, 62 were assigned to an early reconstruction and 59 to rehab with the option of a reconstruction later if they needed one.

At 2 years there was no significant difference between the two groups on the combined knee score, and 36 of the 59 offered the delayed route had not had the operation (Frobell and colleagues, 2010). At 5 years there was still no significant difference, with 30 of the 59 having gone on to surgery, 7 of those between the second and fifth year (Frobell and colleagues, 2013). So roughly half of that group had still not had the operation they had been offered.

The authors did not write that up as a near miss. Their own conclusion is the one to take into an appointment: on these results, they say, clinicians and young, active patients ought to weigh rehab up as a primary treatment after a fresh ACL tear. Primary treatment, not a holding position, for the kind of knee they studied: a fresh tear, in a young active adult, in a knee that had not been injured before.

The UK trial, ACL SNNAP, asked a different question. It recruited 316 people across 29 NHS orthopedic units whose ACL injury was no longer acute and whose knee was still unstable, and it excluded anyone whose meniscus needed surgery straight away. At 18 months the group assigned to surgery scored higher on the same family of knee score, by an adjusted 7.9 points (95% confidence interval 2.5 to 13.2), and the authors concluded that reconstruction as a management strategy was clinically superior for that group. Of the 160 people in the rehab arm, 65 of them, 41%, had surgery within the 18 months, and 43 of the 156 in the surgery arm did not get the operation they were allocated (Beard and colleagues, 2022).

Put the two side by side and the pattern is about the knee in front of you. A fresh tear in someone who has not yet done months of proper loaded rehab is a fair question to ask. A knee that has been unstable for a long time, in someone who has already tried, is a different question, and the answer the UK trial gives leans the other way.

Both trials share one more feature. Everyone in them was in a supervised program, and a meaningful number crossed over in each direction. Neither trial is a promise that a particular path will work for you, which is why the decision is not a page's to make.

Who tends to cope without an ACL, and who usually needs surgery?

OrthoInfo draws the line on what the knee does, not on what the scan says, which makes it a line you can hold against your own week.

Its list is written for an isolated ACL tear, meaning the ligament on its own with nothing else in the knee needing fixing. On the coping side it puts people with a partial tear and no instability, and people with a complete tear who have no instability during daily activities and do not play pivoting or cutting sports, including those in lighter or more sedentary work. On the other side it puts active adults whose sport or job involves pivoting, turning, hard cutting or heavy labor, anyone with functional instability, and people with combined injuries. It notes that activity level matters more than age, which is why a fit 55 year old may be offered a reconstruction and a sedentary 25 year old may not.

What pushes a knee toward the operating list is almost never a number on a report. It is a knee that gives way repeatedly, even in ordinary life. It is a meniscus tear that needs repairing instead of leaving. And it is a sport you are not willing to give up, which the NHS names directly: among the reasons an operation may be needed, it lists wanting to carry on playing a lot of sport, and a knee that goes on giving trouble once physiotherapy has been tried (NHS).

The meniscus one changes the shape of the whole decision, so ask about it by name. OrthoInfo says many meniscus tears are fixable and may heal at a higher rate when the repair is done at the same time as the ACL reconstruction, and the AAOS guideline supports preserving a meniscus where it can be preserved, as an option on limited evidence (Brophy and Lowry, 2023). Neither of the two trials on this page answers for you if your meniscus needs fixing, because the UK trial excluded those knees outright. Once a scan and an examination show a repairable tear, what your surgeon is weighing is no longer only a question about the ligament.

One group this page does not answer for at all is a child or teenager whose growth plates are still open. Both trials recruited adults, average age 26 in the Swedish one, so neither says anything about a growing knee. OrthoInfo says children with ACL tears carry a high risk of later meniscus or cartilage damage when the tear is managed without surgery, and that although reconstructing a knee near an open growth plate brings its own risk of a growth problem, there are techniques that work around the growth plate. That is a conversation for a surgeon who operates on children's knees, not a decision to take from a page.

If more than one ligament was hurt, this page is not the right one. A knee that felt as though it shifted out of place at the moment of injury is in the emergency list below, and MCL sprain covers the ligament on the inside of the knee. A suspected meniscus tear alongside the ACL is covered on meniscus tear, and the same decision for a meniscus is set out on meniscus surgery or physio.

Does trying rehab first make a later operation harder?

The trial evidence we have does not show that it does. Two qualifiers come with that answer, and the second one matters more than most people expect.

In the Swedish trial, the delayed group had no more meniscus operations over 5 years than the early surgery group, whether you count the knees operated on or look at when those operations happened, and the picture held when the authors re-analyzed people by what treatment they actually received (Frobell and colleagues, 2013). That is as close to a direct answer as the literature gets.

The first qualifier is the difference between rehab and drift. Those people were in a structured program, were being reviewed, and had an operation available the moment it was needed. OrthoInfo says most people with ongoing knee instability go on to injure the meniscus within a few years, even where the meniscus was intact when the ACL tore, and that cartilage damage is also more common in a knee that has been ACL deficient for a long time. A knee nobody is watching, giving way every few weeks for a year, is the knee that fits that description.

The second qualifier applies if an operation is already on the table. The AAOS guideline gives a strong recommendation on the timing: once an operation is indicated for a fresh, isolated ACL tear, it is better done early than late, because within 3 months of the injury the risk of further damage to the cartilage and the meniscus begins to climb (Brophy and Lowry, 2023). That sits inside a frame of its own: the guideline says its treatment recommendations are aimed mainly at younger, more active people, and its surgical ones rest on studies of the ACL torn on its own rather than alongside other ligaments.

The guideline summary is also explicit about where the timing recommendation stops applying. It is written for younger, more active patients, and it asks for their operation to be arranged as quickly as it can be. For older, less active patients it applies less: treatment without an operation may suit them well, and surgery may not be indicated for them at the outset at all. Both halves of that sit in the same paragraph of the same document. That is why the two pieces of advice on this page are not fighting each other. The word doing the work in all of it is indicated.

That is not the same question the Swedish trial asked, and the two sit together once you see who each one is talking to. If you and your surgeon are genuinely testing whether your knee copes, with a review booked and the operation available, the trial is the evidence that applies to you. If the decision to operate has already been made and the date keeps slipping, the guideline is the one that applies, and it says the delay is not free.

If that is your situation, tell the surgical team instead of waiting quietly. Ask where you are on the list and what the wait now looks like, and tell them if the knee has started locking, giving way or swelling since you were booked. A new symptom like that is a reason for them to look at the timing again, not something to save for your next appointment.

So the practical answer: trying rehab first is a reasonable plan when somebody is checking the result, a poor plan when nobody is, and a different thing altogether from putting off an operation you have already agreed to. Ask at the start what the review point is and what would change the plan, so the question has a date on it instead of drifting.

Does either path prevent knee arthritis?

This gets implied far more often than it is supported, so here it is flat: having the reconstruction has not been shown to prevent arthritis in the knee.

At 5 years the Swedish trial found no significant difference between the two groups in new radiographic osteoarthritis (P=0.17), alongside no difference in any knee score subscale, in general health, in activity level or in meniscus surgery (Frobell and colleagues, 2013). That is a trial in young adults followed for 5 years, which is a short run at a problem measured over decades, so it is the absence of a demonstrated benefit rather than proof that the choice makes no difference in the long term.

What the same body of work points at is instability as the thing to avoid. A knee that keeps giving way is a knee that keeps taking small injuries, and the meniscus and the cartilage are what pay for them. If arthritis is what worries you, knee osteoarthritis explains what it is and what helps. Then take a question about how stable your knee actually is into your appointment, not a question about the scan.

What the rehab looks like either way

A great deal of this work is identical whichever way the decision goes, which surprises people and is the reason starting now is rarely wasted.

If the operation is going ahead, the same early work has a name. The van Melick guideline recommends a rehab phase before surgery, and ACL prehab exercises sets out what that phase is for and what it contains. If the decision is to carry on without surgery, those same exercises are the opening stage of the program rather than the preparation for one.

Further along, the two paths share their tests as well as their exercises. The strength, hop and control testing used to decide when somebody goes back to sport after a reconstruction is the same testing that tells you whether a knee without an ACL is ready, and ACL return to sport testing describes it. The full stage by stage program, written for after an operation but built on the same principles, is on ACL reconstruction rehab.

There is one real difference. Without a graft healing inside the knee, there is no graft timetable to respect, so progression is governed by swelling, strength and control alone. That sounds like freedom and usually is not, because the limit becomes how the knee behaves instead of a date someone gave you.

Signs the knee is not coping that your surgeon needs to know about

These are the ones to report rather than train through, and the full list with how fast to act is at the foot of this page.

A knee that locks, meaning it is stuck bent and will not fully straighten even after you gently try to move it, is a same day assessment and not a reason to keep going with rehab. A piece of meniscus can be caught in the joint, and where that tear can be repaired, it is repaired better early than late.

A knee that keeps giving way under you, or that gives way and then swells or hurts badly, is a same day call too. Repeated giving way is not a sign that you need to try harder with the exercises. It is the finding that most often changes the plan, and it is the one OrthoInfo links to further damage inside the joint. There is more on what that feels like and what sits behind it on a knee that gives way.

Swelling that comes up within a few hours of a twist, a fall or a blow, or a pop or a snap at the moment it happened, goes to an emergency department the same day. So does a knee that felt as though the whole joint shifted out of place, even if it went straight back, because that can tear several ligaments and can damage the artery or the nerve behind the knee without looking dramatic afterward.

Who decides, and what to ask at your appointment

Your surgeon, with you. That sentence is not a dodge, and the trials above are the reason for it: they give you the odds for groups of people, and nobody in either trial had your knee, your meniscus, your job or your sport.

Take these questions in, written down, because the appointment is short and the decision is not.

Is my tear complete or partial, and does my knee test as unstable when you examine it?
Was anything else damaged, particularly the meniscus or another ligament, and does any of it need repairing?
If I try rehab first, how long for, who reviews it, and what would make you change to surgery?
What would you expect from each path for my sport and my job specifically?
If I go ahead with surgery, which graft would you use and why?
If we agree on surgery, how soon would you want to do it, and what happens to that date if there is a wait?

Then ask the same questions of whoever runs your rehab, because the surgical decision and the rehab plan are made by two different people and both of them should know what the other has said.

This page is education rather than advice about your knee. Nothing here overrides what your surgeon or your physiotherapist has told you about your own ACL tear, and no page can examine a knee.

Related exercise programs

Warning signs

Get emergency help now

Emergency: sudden, severe pain in your lower leg that is much worse than you would expect, especially with a tight bandage or brace on the leg. It may come with a tight, swollen leg, pain that gets worse when the muscle is stretched, numbness, pins and needles or weakness. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be acute compartment syndrome, which needs urgent surgery.
Emergency: the knee has moved out of place, looks misshapen or is pointing at an odd angle, or you have tingling or no feeling in the knee, leg or toes, or your foot turns cold, pale or blue. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
Emergency: the whole knee, not just the kneecap, felt as though it slid or shifted right out of place at the moment of injury, even if it went back straight away, or the knee now feels loose or wobbly in more than one direction. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance. A knee that comes out of place and goes back can tear several ligaments at the same time and can damage the artery or the nerve behind the knee. That damage is not always obvious at first, and the knee can look almost normal, so it is checked in hospital on the day rather than worked out at home.
Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.

Get help today

Same day: the knee is locked, which means it is stuck bent and you cannot fully straighten it, even after gently trying to move it, or you cannot bend or straighten the leg at all. Get assessed the same day by a doctor, at urgent care or at an emergency department. A torn piece of meniscus can get caught in the joint and block it, and when a tear like this can be repaired, it should be done as early as possible. A knee that catches for a moment and then frees itself can happen with a meniscus tear. That is not the same as a locked knee, but tell your physio or doctor about it.
Same day: the knee straightens when someone else moves it for you, but you cannot lift the straight leg off the bed yourself or hold the knee straight against gravity, or you can feel a gap or a dip just above or just below the kneecap. Get assessed the same day by a doctor, at urgent care or at an emergency department. The tendon that straightens the knee can tear, which is not a meniscus or a ligament problem and is not treated with exercises. It is usually repaired, and a tendon repaired late does less well than one repaired early.
Same day: the knee keeps giving way under you, or it gave way after a recent injury, or it gives way and is also very painful or swollen. Get medical advice the same day. If it only happens now and then, with no recent injury and no swelling, it is not an emergency, but book an assessment with a physio or doctor in the next few days. Until it has been checked, leave out the exercises you do standing on one leg, hold the rail on stairs and take care on uneven ground, because a knee that gives way without warning is how people fall.
Same day: you cannot walk or put weight on the leg, whether or not there was a fall or injury, or you have very bad knee pain after a fall or injury, or very bad knee pain that came on suddenly with no injury at all. Get medical advice the same day.
Same day: the knee swells up with no clear reason, especially if you take medicine to thin your blood. Get medical advice the same day.
Same day: the knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.

Book an appointment

Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.

Common questions

How long is recovery from an ACL tear without surgery?

Months either way, and it depends on what you are recovering for. OrthoInfo says a partial tear managed with physical therapy usually takes at least 3 months, and describes a full course of therapy as the thing that shows up whoever is still unstable at the end of it. For a complete tear treated without an operation, the work is the same work the post-surgical programs do minus the surgery: swelling down, the knee fully straight, the thigh muscle switched back on, then strength and control on one leg, then running and changing direction. The two trials behind this page followed people for 2 years, 5 years and 18 months, not for 12 weeks, which tells you something about the scale of the question. Nobody can give you a date at the start, and your physio or physical therapist will set the stages against what your knee can do rather than against the calendar.

Can an ACL tear heal by itself?

Not reliably, and nothing on this page should be read as saying it does. OrthoInfo explains that a torn ACL is generally not repaired but reconstructed with a graft, because the ligament has a poor blood supply, sits in joint fluid, and repairs fail often. The AAOS guideline says the same thing as a strong recommendation: an ACL tear that is going to be operated on should be reconstructed rather than repaired, because repair carries a higher risk of needing revision surgery (Brophy and Lowry, 2023). OrthoInfo does describe a small group who may be candidates for a repair with biological help, which it lists as some partial tears with instability, some lower-demand patients and tears pulled off the thigh bone, decided after a scan and an examination. That is a surgeon's assessment of a particular knee, not a general rule. The sensible way to read the trials is that about half the people in the Swedish trial managed well without the ligament being replaced, not that their ligament grew back.

Can you still play sport without an ACL?

Some people do, and the sport matters more than the ligament. OrthoInfo describes people who cope without a reconstruction as those with a partial tear and no instability, and those with a complete tear who have no instability in daily life and do not play pivoting or cutting sports, including people in lighter jobs. It puts active adults in sports or work involving pivoting, turning, hard cutting or heavy labor on the other side of that line. Instability is the test rather than the scan: a knee that gives way is a knee at risk of damaging its meniscus and cartilage, and repeated giving way is one of the reasons the NHS gives for ending up in surgery after physiotherapy. Take the question to your surgeon with your actual sport named, because badminton twice a week and competitive netball are not the same question.

Will I get knee arthritis if I do not have the ACL surgery?

Having the reconstruction has not been shown to prevent it, which is the part most people have not been told. At 5 years the Swedish trial found no significant difference between early reconstruction and rehab with optional delayed surgery in new radiographic osteoarthritis (P=0.17), and no difference in how many knees had meniscus surgery (Frobell and colleagues, 2013). Five years is a short window for a change that takes decades, so read that as the absence of evidence for a protective effect rather than proof that neither path matters. The AAOS guideline does not claim a protective effect either: its only recommendation on what a reconstruction buys in the long run is graded an option on limited evidence, and it is about meniscus damage, pain and function rather than about arthritis (Brophy and Lowry, 2023). What is clearer is that a knee that stays unstable takes further damage: OrthoInfo says most people with ongoing knee instability develop a meniscus injury within a few years even when the meniscus was intact at the time of the tear. So the arthritis question is really the instability question.

Is a partial ACL tear different?

It can be, and the first thing to know is that it is rarer than people expect. OrthoInfo says partial tears of the ACL are rare and that most ACL injuries are complete or near complete tears. Where a tear is genuinely partial, it says those may be treated without an operation, with progressive physical therapy and rehabilitation, that recovery usually lasts at least 3 months, and that some people still feel instability afterward from a loose ACL, which is why it asks for close follow-up and a complete course of therapy rather than a few weeks. Complete tears, on the same page, typically do less well without surgery because of instability. The word partial on a scan report is not a promise, though. Whether your tear behaves like a partial one is decided by how your knee performs when it is loaded and tested, not by the radiologist's wording, and your surgeon and physio are the ones who see both.

Does waiting and trying rehab first make a later operation worse?

The trial evidence available does not show that it does, in the population it studied. In the Swedish trial, the group given rehab with the option of surgery later had no more meniscus operations over 5 years than the early surgery group, by number or by timing, and the results held when the authors analyzed people by the treatment they actually received (Frobell and colleagues, 2013). Those were young, active adults with a fresh tear getting structured, supervised rehab. That is not the same as a knee left alone, giving way every few weeks, for a year. OrthoInfo is clear that long-standing instability goes with meniscus and cartilage damage, and the UK trial recruited exactly that kind of knee and found the group assigned to reconstruction scored better (Beard and colleagues, 2022). There is also one point where the evidence does say waiting costs something. Where surgery is already indicated for an acute isolated tear, the AAOS guideline gives a strong recommendation for early reconstruction, because the risk of additional cartilage and meniscus injury starts to increase within 3 months of the injury (Brophy and Lowry, 2023). So trying rehab properly is not the same as waiting, and putting off an operation you have already agreed to is different again.

References

Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine. 2010;363(4):331-342. https://doi.org/10.1056/NEJMoa0907797
Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232. https://doi.org/10.1136/bmj.f232
Beard DJ, Davies L, Cook JA, et al. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial. The Lancet. 2022;400(10352):605-615. https://doi.org/10.1016/S0140-6736(22)01424-6
Davies L, Cook J, Leal J, et al. Comparison of the clinical and cost effectiveness of two management strategies (rehabilitation versus surgical reconstruction) for non-acute anterior cruciate ligament injury: study protocol for the ACL SNNAP randomised controlled trial. Trials. 2020;21(1):405. https://doi.org/10.1186/s13063-020-04298-y
Brophy RH, Lowry KJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2023;31(11):531-537. Guideline approved by the AAOS Board of Directors 22 August 2022. https://doi.org/10.5435/JAAOS-D-22-01020
Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 2023;57(9):500-514. https://doi.org/10.1136/bjsports-2022-106158
van Melick N, van Cingel REH, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British Journal of Sports Medicine. 2016;50(24):1506-1515. https://doi.org/10.1136/bjsports-2015-095898
American Academy of Orthopaedic Surgeons. ACL injury: does it require surgery? OrthoInfo. https://www.orthoinfo.org/en/treatment/acl-injury-does-it-require-surgery/
NHS. ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/what-it-is/
NHS. Recovering from ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/recovering/
NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-24.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.