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ACL rehab (non-operative & post-operative): phases, what to expect, and practical next steps

An ACL tear is a big moment, but it doesn’t have to be the end of running, sport, or an active life. Rehab – whether you go non-operative or post-operative – is about much more than just getting the swelling down and “feeling okay”. It’s about rebuilding strength, control, confidence, and the ability to trust your knee again in real-world situations.

 

This page explains the typical ACL injury pattern, when surgery versus non-operative management might be considered, the key phases of rehab, and how return-to-sport decisions are made using criteria, not just dates. It’s written for active adults in Melbourne who want straight, evidence-informed answers.

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What you’ll learn on this page

  • How ACL injuries usually happen and what non-op vs surgery decisions hinge on

  • The main phases of ACL rehab (non-op and post-op) and what they focus on

  • How return-to-running and return-to-sport decisions are made using strength, hop tests, and timeframes 

Typical ACL injury patterns & symptoms

​An ACL injury often happens during pivoting, cutting, or landing movements, especially in field and court sports (netball, football, soccer, basketball, skiing). Common features include:

  • A twist or pivot on a planted foot, or awkward landing from a jump

  • A feeling of the knee “giving way”, “popping”, or a sudden shift

  • Rapid swelling within hours, sometimes with difficulty weight-bearing

  • Ongoing instability in pivoting or cutting movements in some people

 

However, not everyone has dramatic swelling or instability long term. Some people adapt well and can manage higher-level activity with non-operative rehab; others feel unstable and choose reconstruction.

Do I need surgery, or can I go non-operative?

​There’s no one-size-fits-all answer. The decision usually depends on your age, sports, work demands, knee stability, and goals – not just the MRI.

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Non-operative (conservative) ACL management

Non-operative management is more likely to be considered if:

  • You’re less involved in pivoting/cutting sports,

  • Your knee feels reasonably stable in day-to-day life after early rehab,

  • You’re willing to adjust sports or surfaces if needed.

 

Recent work suggests many adults, including those in middle age, can do well with structured non-operative rehab, although some may eventually choose surgery if instability persists or activity demands change.

 

ACL reconstruction (surgical) management

Surgery is more likely to be considered if:

  • You want to return to pivoting/cutting or high-level sports,

  • Your knee continues to buckle or give way despite good rehab,

  • There are associated injuries (e.g. significant meniscus or ligament damage) that make reconstruction more advisable.

 

Australian and international guidelines emphasise shared decision-making – discussing pros and cons of non-op vs surgical paths with your surgeon, GP, and physio, rather than rushing in either direction.

How we approach ACL rehab at The Hip and Knee Physio (Camberwell)

​At The Hip and Knee Physio, ACL rehab is built around your sport, your knee, and your decisions – whether you go non-operative or post-operative.

 

In your initial sessions we will typically:

  • Clarify your goals – sport level, work demands, timelines (holidays, seasons), and non-negotiables

  • Review your injury history, imaging, and any surgical details

  • Assess knee range, swelling, gait, strength, and single-leg control

  • Screen for associated issues (meniscus, collateral ligaments, patellofemoral pain, fat pad irritation) and broader kinetic chain factors

 

From there you get:

  • A clear explanation of what your current phase is and what realistically matters right now

  • A progression roadmap (e.g. “these are our targets before running”, “these are our targets before change of direction”) rather than a vague “see how it goes”

  • Collaboration with your surgeon, GP, or strength & conditioning coach where relevant

 

Non-op and post-op paths both use the same principles: build capacity, build control, and earn the right to progress.

FAQs – ACL

1. Can I avoid surgery with an ACL tear?

Some people do very well with non-operative ACL rehab, particularly if they are less involved in pivoting/cutting sports and gain good strength and control. Mid-term data suggest many adults, including middle-aged patients, can be managed non-operatively, though some later choose surgery if instability persists or goals change.

 

Surgery vs non-op should be a shared decision based on your sport, work, knee stability, and goals – not just the scan.

 

2. When can I start jogging after an ACL tear/reconstruction?

There’s no magic date, but many protocols look for:

  • Settled swelling

  • Near-full extension and good flexion

  • Reasonable strength and single-leg control

 

For post-op patients this is often several months down the track rather than weeks. The key is that the knee has earned it, not that the calendar says you “should” be running.

 

3. Why is my knee still swollen months after surgery?

Low-level swelling can hang around for a while after ACL reconstruction, especially when you increase load. If swelling spikes after activity and lingers, it may be a sign that either:

  • The knee isn’t tolerating the current load,

  • There’s residual irritation from other structures (e.g. fat pad, synovitis, meniscus), or

  • You’ve jumped phases too quickly.

 

This is something to discuss with your physio and surgeon. It doesn’t automatically mean something is “ruined”, but it is a signal to pay attention to.

 

4. Is 6 months enough to return to sport?

For pivoting/cutting sports, current evidence suggests that returning before ~9 months after reconstruction is associated with higher re-injury rates, and that delaying RTS and achieving better strength symmetry reduces risk.

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Some non-contact, straight-line or lower-demand activities may be appropriate earlier, but for high-risk sports the combination of time + criteria is what matters.

Book Now

If you’ve torn your ACL and you’re trying to decide between non-operative management and surgery – or you’ve already had reconstruction and want a clear, criteria-based rehab plan – a structured assessment can help you work out your next steps.

  • Book an ACL rehab consultation in Camberwell – Book Now

  • Prefer to talk first? Contact the clinic to discuss whether an appointment is appropriate for your situation.

Local practicals – Camberwell clinic

​The Hip and Knee Physio consults from 1/3 Prospect Hill Road, Camberwell, a short walk from Camberwell Junction and public transport. The building offers good access and facilities, including accessible entry and amenities, and there is parking available nearby.

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