# ACL Rehabilitation in Perth

> Criterion-based, 5-stage rehabilitation that gets athletes back to sport safely — with objective testing at every stage, not guesswork.

## Overview
ACL rupture is one of the most significant sports injuries. The risk of re-injury — particularly re-rupture of the graft or injury to the other knee — is substantially reduced when return to sport is based on objective criteria rather than time alone. This is the foundation of how we approach ACL rehabilitation at Move Physiotherapy.

Following either conservative management or surgical reconstruction, rehabilitation is structured and criterion-based — each stage is gated by objective strength testing before progression. We can refer you directly for MRI to confirm the diagnosis without needing a GP referral first.

Both conservative and post-surgical ACL rehabilitation respond well to the right programme. The timeline varies, but the approach is consistent: restore strength, restore symmetry between legs, and return to sport only when the data supports it.

We see ACL patients across our four Perth clinics: Beeliar, Booragoon, East Fremantle, and Jandakot. No referral is needed to book.

## Common Causes
- Non-contact mechanism — pivoting, cutting, or landing with knee in valgus collapse (most common)
- Direct contact — valgus force from tackle or collision
- Hyperextension mechanism — landing or pivoting on a straight knee

## Our Treatment Approach
- **Pre-Op Optimisation** — Restore full range of motion, reduce swelling, and build quadriceps strength before surgery — patients with better pre-op quadriceps function achieve better post-op outcomes.
- **Early Post-Op** — Weight-bearing progression, swelling management, range of motion restoration, and quad activation within surgical protocol guidelines.
- **Strength & Neuromuscular** — Progressive quadriceps, hamstring, and hip strengthening with VALD testing. Graft protection throughout this phase is critical.
- **Running & Plyometrics** — Return to running initiated when strength criteria are met. Progressive plyometric loading assessed against LSI thresholds.
- **Return to Sport** — Sport-specific training and contact cleared only when LSI is 90% or greater, psychological readiness confirmed, and functional testing passed — typically at 9-12 months.

## What to Expect
Return to pre-injury level of sport following ACL reconstruction is achieved by approximately 55-65% of athletes at 12 months, rising to 80%+ when criterion-based rehabilitation is implemented. [2]

Re-injury risk is significantly reduced when return to sport is delayed until 9+ months post-surgery and quadriceps limb symmetry index (LSI) exceeds 90%. Athletes who return before 9 months have a 4-fold increase in re-rupture risk.

## When to Seek Help
Physiotherapy should commence within days of ACL injury — both for pre-operative optimisation (prehabilitation) and psychological preparation. Patients who complete prehabilitation achieve significantly better post-operative outcomes.

## Frequently Asked Questions
### Do I need ACL surgery?
Not necessarily. ACL rupture can be managed conservatively in individuals who do not participate in pivoting sports, have low instability demands, and are willing to modify their activity level. However, young athletes in pivoting sports typically achieve better long-term outcomes with reconstruction, particularly given the associated meniscal and cartilage injury risk with ongoing instability.

### When can I return to sport after ACL surgery?
Return to full contact sport should occur no earlier than 9 months post-surgery, and only when objective criteria are met — specifically quadriceps limb symmetry index 90% or greater (VALD tested), passing of sport-specific hop testing, and psychological readiness assessment. Athletes who return before 9 months have a 4-fold increased re-rupture risk.

### How long is ACL rehabilitation?
A comprehensive ACL rehabilitation programme takes 9-12 months to return to contact sport, and up to 2 years for full graft maturation. The timeline is guided by objective criteria, not a fixed schedule.

### What is the ACL re-injury rate?
Young athletes under 25 who return to pivoting sport have re-injury rates of 15-25% over 5 years. These rates drop significantly with criterion-based rehabilitation and delayed return to sport. Females have approximately 3-4 times the ACL injury rate of males in the same sport.

### What is prehabilitation and why is it important?
Prehabilitation — physiotherapy before surgery — focuses on reducing swelling, restoring full range of motion, and maximising quadriceps strength before the operation. Strong pre-operative quadriceps function is one of the most consistent predictors of post-operative outcome.

## References
1. Grindem H, et al. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction. Br J Sports Med, 50(13), 804-808.
2. Ardern CL, et al. (2011). Return to sport following anterior cruciate ligament reconstruction surgery. Br J Sports Med, 45(7), 596-606.

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Move Physiotherapy & Fitness — Perth, WA. [Book an appointment](https://movephysiotherapy.com.au/book-online) · Phone 08 6113 8062
Canonical page: https://movephysiotherapy.com.au/conditions/acl-injuries