What is an ACL? (Anterior Cruciate Ligament)

The diagram on the right shows the main structures in a healthy (right) knee.

The ACL joins the back of the femur (thighbone) to the front  of  the tibia (shinbone). It helps to stabilise the knee. You can damage it by a twisting movement or a movement where your body continues to move forwards but your foot stays put. E.ge dodging, pivoting or landing from a jump. The main goals of ACL surgery and rehabilitation are to restore knee stability and to allow your return to work and sport as soon as possible.

Surgery (Anterior Cruciate Ligament)

Reconstruction of an ACL involves replacing the torn ligament usually with part of the hamstring, from behind the knee or sometimes part of the patellar tendon or quadriceps tendon.

The surgeon drills tunnels through the bone. Your new ACL is brought through these tunnels, and then secured. As healing occurs, the bone tunnels fill in to secure the tendon.


Why do I need physiotherapy after my operation?Rehabilitation starts immediately after your surgery.  The rehabilitation is just as important as the surgery itself. You need commitment and effort to make the most of your rehabilitation.

To make sure your progress is quick and safe your physiotherapist(s) will follow a specially designed programme based on up to date information.

•            To minimise swelling

•            To regain full range of movement

•            To restore normal walking

•            To strengthen muscles

•            To allow safe return to sporting activities

Your physiotherapy care

– Immediately after surgery

You will return from theatre with a padded crepe bandage from your calf to thigh.

You may have had local anaesthetic put into your knee. These often cause numbness and a feeling that you are unable to move your leg. This is normal and usually improves within a few hours. The\ staff will offer painkillers and we strongly advise you to take these regularly to minimise discomfort and swelling. The padded bandage will change to a light wound covering and tubigrip.

– Going home from hospital

We will give you walking sticks or crutches to help you walk and to get about, until you have better control of your leg muscle. We will show you how to use them properly to walk and when on stairs.

It is really important that you take good care of your wound and pain control. It is also important to keep down any swelling.


Wound pain is normal, this will gradually lessen over the next few days. Use the painkillers supplied regularly as prescribed. If pain or swelling increase contact us

Wound Care

Change the clear wound dressing. You may see dark blood stains – don’t worry this is normal.

If your wound becomes hot, red and weeps fluid, contact us

Swelling and heat

Swelling is normal immediately after surgery. Use a cold pack if your knee is hot and swollen. You can make a cold pack by wrapping a bag of frozen peas in a damp tea towel. Remove the tubigrip and apply the cold pack to your knee for not more than 15 minutes at a time. You may reapply it once your knee has returned to its normal temperature. Wear the tubigrip during the day but remove it at night to allow your circulation to flow properly.

Going up stairs

1. Place crutches or stick down onto step

2. Place operated leg onto same step

3. Finally place unoperated leg onto same step

Going down stairs

1.    Place unoperated  leg up  onto step

2.    Place operated leg onto same step

3.    Finally place sticks or crutch onto step

Remember –

“Up with the good, and down with the bad”

Always use your crutches or sticks to support the operated leg.

Always use the handrail, if there is one, as well as one stick or crutch.

When can I return to normal activities?

Every individual is different and you should follow the advice of your physiotherapist. The following is a rough guideline:

  • Walking without crutches: as advised by your physiotherapist
  • Work at a desk: approximately 2 – 4 weeks
  • Other jobs: depends on activity
  • Driving: approximately 4 – 6 weeks
  • Return to sport: as advised by your physiotherapist

ACL Surgery Exercises

Your exercise programme should start from day one and has been carefully designed for safe and rapid progress.