ACL (anterior cruciate ligament) reconstruction is one of the most significant knee surgeries a person can undergo. Getting rehabilitation right — from day one through to full return to sport — is the single most important factor in achieving a successful outcome. At Burwood Physio, we provide comprehensive ACL rehabilitation for patients from Burwood, Strathfield, Concord, Croydon, and across Sydney’s inner west.
What Is the ACL and Why Is It Important?
The anterior cruciate ligament runs diagonally through the centre of the knee joint, connecting the femur (thigh bone) to the tibia (shin bone). Its primary roles are to prevent the tibia from sliding forward on the femur and to control rotational forces through the knee. The ACL is critical for dynamic knee stability during cutting, pivoting, jumping, and change-of-direction movements.
ACL tears occur most commonly in contact and change-of-direction sports such as AFL, rugby, soccer, netball, basketball, and skiing. The majority are non-contact injuries — typically a deceleration, cutting, or landing movement — which is why ACL injury prevention training is so important.
ACL Reconstruction Surgery
When the ACL is completely torn, surgical reconstruction is usually recommended for active individuals who wish to return to sport or physically demanding work. The surgery replaces the torn ligament with a graft — most commonly:
- Hamstring graft — harvested from the semitendinosus and gracilis tendons; lower donor-site morbidity
- Bone-patella-bone graft — strong bone-to-bone healing; commonly used in elite athletes
- Quadriceps tendon graft — increasingly used, particularly in revision ACL surgery
The graft is fixed with screws or endobuttons and undergoes a process of ligamentisation over 12–18 months before it reaches full strength.
The Phases of ACL Rehabilitation
Phase 1 — Immediate Post-Operative (Weeks 0–2)
Goals: manage swelling and pain, restore full knee extension, activate the quadriceps.
- RICE (rest, ice, compression, elevation)
- Gentle range of motion exercises
- Quadriceps setting and straight leg raise
- Weight-bearing with crutches as directed by surgeon
- Scar tissue massage after wound closure
Phase 2 — Early Rehabilitation (Weeks 2–6)
Goals: restore full range of motion, build quadriceps and hamstring strength, normalise gait.
- Progressive weight-bearing and gait retraining
- Stationary cycling (when range permits)
- Leg press, mini squats, step-ups
- Hip strengthening — abductors and external rotators
- Pool walking and hydrotherapy
Phase 3 — Strength Development (Weeks 6–16)
Goals: restore lower limb strength to ≥80% symmetry, develop single-leg control.
- Single-leg squat and lunge progressions
- Romanian deadlift and hamstring loading
- Progressive running introduction (straight-line jogging from ~12 weeks, graft-dependent)
- Balance and proprioception training
- Sport-specific conditioning
Phase 4 — Return to Running and Agility (Weeks 16–24)
Goals: full running capacity, agility, and neuromuscular control. Criteria-based progression (not time-based).
- Agility ladder, change-of-direction drills
- Plyometric progressions — hopping, bounding, jumping
- Sport-specific movement patterns
- Psychological readiness assessment
Phase 5 — Return to Sport (Months 6–9+)
Goals: safe return to full training and competition. Objective criteria must be met before clearance.
Return to sport criteria at Burwood Physio include:
- Limb symmetry index ≥90% on hop tests
- Quadriceps and hamstring strength ≥90% symmetry
- Knee confidence and psychological readiness
- Successful completion of sport-specific training without symptoms
Why Criteria-Based Progression Matters
Research shows that returning to sport before achieving adequate strength and neuromuscular control dramatically increases re-tear risk. Athletes who return before 9 months have a re-tear rate up to 5 times higher than those who return after. At Burwood Physio, every phase transition is based on objective criteria, not just time elapsed since surgery.
Pre-Surgery Rehabilitation (“Prehab”)
If you are awaiting ACL reconstruction, prehabilitation is strongly recommended. Research consistently shows that patients with good pre-operative quadriceps strength and range of motion achieve significantly better post-surgical outcomes. We provide ACL prehab programmes at Burwood Physio from the time of injury through to surgery.
Book Your ACL Rehabilitation at Burwood Physio
Whether you are pre-surgery, freshly post-operative, or stuck at a plateau mid-rehab, our experienced physiotherapists will help you achieve the best possible outcome. We work closely with your surgeon and provide detailed progress reports at key milestones.
Located at Shop 2, 36-38 Victoria St E, Burwood NSW 2134. HICAPS on-site, all health funds, WorkCover and CTP accepted.
Call 02 8322 9022 or book online.