Knee ACL Reconstruction

The anterior cruciate ligament (ACL) plays an important role in maintaining knee-joint stability, primarily through limiting anterior tibial translation on the femur and restraining rotation, but also by resisting varus and valgus forces at the knee.

The ACL is commonly injured via a non-contact mechanism during sports participation, particularly in sports involving jumping, pivoting and cutting manoeuvres.

In Australia, 90% of all ACL injuries will undergo surgical reconstruction.

In patients under the age of 18 that undergo ACL Reconstruction (ACLR), 30% will sustain another ACL injury to the surgical graft, or the other ACL, within 15 years of having their first surgery. In those over 30 years of age, 14% will reinjure their surgically repaired graft within 2 years.

Around 80% of people will return to any level of sport, with 65% returning to pre-injury level of sport, and 55% of people returning to some form of competition within 2-7 years following ACLR.

ACL re-Injury rates are decreased by 5% each month that Return to Sport (RTS) was delayed until month 9 post-op.

Taking a detailed history with injury mechanism is crucial in developing suitable rehabilitation strategies.

A thorough physical examination is then performed to ensure suitable recovery and no post-operative complications.

Goals and Expectations are discussed and a management plan is established together.
Current evidence supports a graduated rehabilitation process, which is determined by criteria to progress, rather than a pre-determined timeline

The Melbourne Return to Sport Score (MRSS) is an assessment tool used as a guide and is broken down into 5 phases, with goals and criteria to progress at each stage, as developed by Mick Hughes , Sports Physiotherapist and Randall Cooper, Specialist Physiotherapist in Melbourne.