I recently spent a few days away in Adelaide where the Australian Physiotherapy Association (APA) hosted their annual conference to present the most recent up-to-date research on varying issues. Adelaide is a wonderful city filled with wonderful views, sunsets and excellent food! Here’s a photo of the lovely sunset whilst I was there!
Looking at clients with ACL reconstructions (9 to 36 months post surgery)
A big theme at the conference was understanding what truly influences recovery after an ACL reconstruction.
Interestingly, strength was not the biggest predictor of someone’s function or quality of life. While strong muscles absolutely matter, the research showed that around 38 percent of improvement came from reducing fear of movement.
Fear after an ACL injury is very common. Feeling hesitant to twist, change direction, land from a jump or trust the knee again can all affect recovery. Building confidence with movement is proving to be one of the most important parts of successful long term ACL rehab.
ACL tears – to have surgery or not to have a surgery?
Many people assume that an ACL tear automatically means surgery, but current research suggests a more flexible approach.
More evidence now supports beginning with conservative rehabilitation. This simply means starting with a structured program (typically delivered by a physio initially) that includes targeted strengthening, balance training, movement retraining and gradual exposure to the activities you want to return to.
For a large number of people, this approach restores enough function that surgery may not be needed. If surgery is required later, people often go in stronger and more confident, which usually helps recovery go more smoothly.
This applies even to those wanting to return to higher level sport. Both pathways can work well, and the best decision depends on your goals, your activities and how your knee responds to early rehabilitation.
A decision aid tool is available to help you compare non surgical ACL treatment with ACL reconstruction. It is a simple way to understand the pros and cons before speaking with a physio, GP or surgeon. You can access it here.
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So, in conclusion...
Movement builds confidence, and confidence drives recovery. The more closely your rehabilitation reflects your goals, the better your knee learns to cope with real life demands.
🔹 If stairs feel difficult, we practise stairs.
🔹 If basketball is your aim, we work on jumping, landing, pivoting and change of direction.
🔹 If running is your priority, we build tolerance gradually so your knee feels ready.
And if you are unsure whether ACL surgery is the right step for you, the decision aid tool is a helpful starting point.
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Still unsure what your best next step is?
ACL injuries can feel overwhelming and it is completely normal to be unsure about surgery, timelines or how to regain confidence. A physio can guide you through your options, help you understand how your knee is functioning and work with your GP or surgeon if needed.
You don’t need to navigate the decision alone. If you would like personalised advice, we are here to help you get moving with clarity and confidence.