ACL Rehab — testing, not guessing
Coming back from an ACL reconstruction is a long road, and how you come back decides whether it holds. We run criteria-based rehab driven by objective strength and jump testing — so you return to running and sport when the knee is genuinely ready, not just when the calendar says so.
Testing, not guessing
ACL rehabilitation is a long, structured journey — and the single biggest mistake is returning to sport by the calendar rather than by the knee. We progress you on objective testing: strength, single-leg hop and jump symmetry, landing control and movement quality. That is where our VALD force-plate testing and return-to-play profiling come in — numbers you can trust, not a hopeful guess.
Different grafts, different rehab
An ACL reconstruction rebuilds the ligament using a graft — and the type of graft affects both the early rehab and the things to watch for. The main options are:
Hamstring tendon (HT)
The graft is taken from your own hamstring tendons. Very commonly used, with less pain at the front of the knee and with kneeling. Some studies show a slightly higher rate of graft laxity or re-rupture in young, pivoting athletes, which is one reason objective testing before return matters.
Bone–patellar tendon–bone (BPTB)
A strip of the patellar tendon with a block of bone at each end. Strong, secure fixation and, in several studies, lower re-rupture rates in young, high-risk athletes — at the cost of more anterior knee and kneeling pain early on.
Quadriceps tendon
An increasingly popular alternative, taken from the tendon above the kneecap. A good option in many cases; your surgeon chooses the graft that suits you, and rehab is tailored to the graft you have.
What an ACL reconstruction actually involves
On the left, the natural ACL running through the centre of the knee. In the middle, a graft has replaced the torn ligament — passed through tunnels drilled in the thigh bone and shin bone, and held with fixation devices while it heals in. On the right, the arthroscopic (keyhole) view the surgeon works from: clearing the torn stump, preparing the tunnels, passing the graft and tensioning it. The graft is strong on day one, but it has to biologically remodel over many months — which is exactly why rehab is paced to the knee, not the calendar.
When can I run again?
Running returns when the knee is ready, not on a fixed date — usually from around 12 weeks, and only once you have the strength, control and movement quality to handle it. We use strength and hop testing to make that call, in line with evidence-based ACL rehabilitation (van Melick et al., 2016). Rushing it is how niggles — and re-injuries — start.
Why 9 months — and why the tests decide
The evidence here is striking. In the Delaware–Oslo study, every extra month before returning to sport (up to 9 months) cut the re-injury rate by 51%, and athletes who returned before 9 months had roughly double the re-injury rate of those who waited. Crucially, those who passed a return-to-sport test battery had a re-injury rate of about 6%, versus 38% in those who failed — the basis for the paper’s title: “simple decision rules can reduce re-injury risk by 84%” (Grindem et al., 2016).
Why we adapt the plan by sex
Female athletes carry a higher risk of both first-time ACL injury and re-injury than male athletes, linked to differences in landing mechanics, neuromuscular control, anatomy and hormonal factors. It doesn’t mean a different graft — it means rehab places extra emphasis on landing and change-of-direction control, single-leg strength and jump quality, and a patient, criteria-led return. We build those priorities into the testing from the start.
Watch an ACL reconstruction
A short video of the surgery — some people find it reassuring to see what has been done inside the knee before they start rehab. (Surgical footage; viewer discretion.)
Sources & further reading
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016;50(13):804–808. bjsm.bmj.com
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. Br J Sports Med 2016;50(24):1506–1515. bjsm.bmj.com
Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 2016;44(7):1861–1876. journals.sagepub.com
Physiotherapy assessment for ACL rehabilitation
Your first appointment is a proper assessment, in two parts:
Subjective assessment
A detailed discussion about how it started, what makes it better or worse, how it is affecting your work, training and daily life, and your goals — including any event you are building towards.
Objective assessment
A hands-on examination — strength, movement, loading and specific tests — to pin down the diagnosis and what is driving it. Where it will change your plan, we can arrange diagnostic ultrasound scanning in-house.
Book your ACL assessment
Whether you’re fresh out of surgery or stuck part-way through rehab, we’ll test where you really are and build the criteria-based plan to get you back running, then back to sport, safely.