ACL Tears in Australia: Symptoms, Do You Need Surgery, and How Long Recovery Really Takes
- Emma Glynn
- Aug 25, 2025
- 5 min read
Updated: Sep 5, 2025
TL;DR
Some ACL injuries cope without surgery especially partial tears and adults in non-pivoting sports when you follow a structured physio-led program and meet objective “coping” criteria [2,3].
Surgery is appropriate for persistent instability, multi-ligament injuries, or athletes returning to cutting/pivoting sports after failing a prehab trial [1].
Recovery time: non-operative pathways often return people to jogging 8–12 wks and sport demands 6–9+ months if criteria are met; post-op return to cutting/pivoting sport is 9–12+ months, guided by strength, agility, hop-test and pyschological readiness criteria, not time alone [4–6,9].
You can usually walk on a torn ACL once swelling settles; instability shows with twisting/pivoting.
MRI helps when the exam is unclear or to assess meniscus/associated injury; it’s not always essential day one [1].
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What (and Where) Is the ACL?
The anterior cruciate ligament sits inside the knee, connecting femur to tibia. It limits forward slide and rotational load, it's a key structure for stability in sports such as netball, soccer, AFL and quick changes of direction.
Signs & Symptoms
A pop at injury
Delayed swelling (1–2 hrs+ after injury)
Feeling the knee “give way” with twists/pivots
Reduced extension or locking if the meniscus is involved
Diagnosis combines history + clinical tests; MRI confirms extent/associated injury when needed [1].
Can an ACL Heal Without Surgery?
The ACL tissue itself heals poorly, but many people function normally without reconstruction using progressive strength, neuromuscular control, and movement strategies [2,3].
Often suitable for non-operative care (“copers”):
Adults in straight-line/non-pivoting sports
Partial tears
Knees that stop giving way after early rehab
More likely to need surgery: ongoing instability despite rehab, combined injuries, or athletes targeting high-demand pivoting sports [1].
Best practice: a 4–6-week “prehab” block to settle swelling, restore extension/strength, then test function to guide the decision with your surgeon/physio [1–3].
Do You Need an MRI?
Helpful if the diagnosis is unclear, to evaluate meniscus/other ligaments, or if recovery isn’t following the expected course. Not always urgent on day one [1].
Non-Surgical ACL Rehabilitation (Overview)
Phase 1 (0–2 wks): calm the joint, regain full extension, quad activation, bike/heel slides.
Phase 2 (2–16 wks): progressive quads/hamstrings/glutes, balance/perturbation, gait retraining; criteria to jog = full/near-full ROM, minimal effusion, single-leg control.
Phase 3 (4-9 mths): running progression, landing mechanics, linear → curved → cutting patterns.
Phase 4 (9+ mths): sport-specific chaos, fatigue testing; ≥90% limb symmetry on strength and hop tests before full return [4–6,9].
Surgical Pathway (If Indicated)
Reconstruction uses a graft (hamstring/patellar/quad tendon). Prehab improves outcomes (extension, quads) [1].Typical milestones:
0–6 wks: settle, regain extension, bike
6–12 wks: strength, balance, gait
3–6 mths: running, controlled agility
9–12+ mths: return if objective criteria (not time alone) are met [4–6,9].
Braces & Taping
Useful for confidence early or specific tasks; they don’t replace strength/control training [1].
Partial vs Complete Tears
Partial: often trial non-operative rehab first; some return to sport without surgery [1–3].
Complete: decision hinges on age, sport, instability; use prehab + testing to decide [1–3].
ACL vs Meniscus - What’s the Difference?
ACL = stability in translation/rotation. Meniscus = shock absorption; tears may cause catching/locking. Management changes if the meniscus needs repair (which may influence surgery timing) [1].
When to Seek Care Urgently
Locked knee (can’t straighten),
Repeated giving way in daily life,
Red flags: fever, night pain, unusual swelling, suspected multi-ligament injury or fracture.
Book an ACL Consult
Stuck in the “surgery vs rehab” loop? We’ll perform a clear assessment, start a prehab block, and use objective tests to map the safest, fastest route back to what you love. Book now or send a question via the contact form on our homepage.
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FAQs
Can an ACL heal without surgery?
The ligament rarely heals “good as new,” but many people function normally with a criteria-based rehab program. Decide after a short prehab and testing block [2,3].
How long is ACL recovery?
Non-operative: 3–9+ months depending on sport and criteria. Surgical: 9–12+ months for pivoting sports, based on objective testing not time alone [4–6,9].
Can you walk with a torn ACL?
Often yes once swelling settles, but twisting/pivoting can feel unstable. Your plan targets gait, strength, and dynamic control [1].
Do I need an MRI?
Useful to evaluate meniscus/associated injuries or when the clinical picture is unclear; not always essential immediately [1].
Is bracing necessary?
It can help confidence early; the cornerstone is strength + neuromuscular control [1].
Partial vs complete tear- does it change treatment?
Yes. Partial tears commonly trial non-operative rehab first; complete tears depend on instability, age, and sport demands [1–3].
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References
American Academy of Orthopaedic Surgeons (AAOS). Management of Anterior Cruciate Ligament Injuries: Clinical Practice Guideline. 2022.
Frobell RB, et al. Treatment for acute anterior cruciate ligament tear: a randomized trial comparing structured rehabilitation plus early ACL reconstruction vs rehabilitation with optional delayed reconstruction. N Engl J Med.2010;363:331–342.
Frobell RB, et al. Treatment for acute ACL tear: five-year outcome of a randomized trial. BMJ. 2013;346:f232.
Ardern CL, et al. Return to sport following ACL reconstruction: a systematic review and meta-analysis. Br J Sports Med. 2011;45(7):596–606.
Grindem H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction. Br J Sports Med. 2016;50(13):804–808.
van Melick N, et al. Evidence-based clinical practice guideline for ACL rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2016;24:1–19.
Webster KE, Feller JA. Younger age is associated with increased risk of graft rupture and contralateral injury after ACL reconstruction. Am J Sports Med. 2016;44(7):1861–1876.
Beischer S, et al. Quadriceps strength and risk of second ACL injury. Br J Sports Med. 2020;54(13):1007–1012.
Filbay SR, Grindem H. Evidence-based recommendations for ACL rehabilitation and return to sport. Br J Sports Med. 2019;53(23):1432–1433.
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