Skip to main content


The Anterior Cruciate Ligament is located at the center of the knee. Its role to support and stabilise the knee joint, preventing the shin bone from sliding forward.

(Dressendorfer & Watkins, 2017)

As you can see from the image above, the ACL runs from the back of the femur (thigh bone) to the front of the tibia (shin bone). Consequently, injuries occur as a result of excessive stress placed on the ACL.

This is typically seen with movements such as twisting when the knee is extended (such as cutting movements in sports) or when an external force is applied to the outer side of the knee.

Types of ACL Reconstructions

As the ACL does not have the capacity to heal on its own, surgery is the recommended treatment option for a torn ACL, especially for the younger population and athletes. Surgery typically involves a tendon graft to remodel and reconstruct the ACL.


The ACL is reconstructed from a (your) tendon, a portion of the tendon is removed and used to remodel the ACL. The most common autografts include Hamstring, patella tendon & quadriceps.
The considerations with this type of reconstruction,
  • Healing time of the muscle/tendon
  • Strength
  • Proprioception
  • Neuromuscular control
  • Reduced range of motion of the grafted muscle
These factors will need to be considered during post-op rehabilitation.


The ACL is reconstructed from a donor tendon (cadaver). This type of graft is beneficial as there is no direct effect on any other muscle. However, there is an increased risk of infections due to foreign tendons used.


Immediately following an ACL reconstruction, rehabilitation will usually involve multiple phases (acute, mid, and late stages), each with specific goals. Following the achievement of phase goals, progression to the next stage is safe to commence.
The last stage of rehabilitation is expected to last between 6-12 months post-surgery. Ideally, the individual should have full knee range of motion, is pain-free, has good neuromuscular control, and a foundation of strength and power.

The goals of late-stage ACL rehabilitation include the following:

  • Improve cardiorespiratory fitness
  • Progress strength and power
  • Progress unilateral (single-leg) symmetry
  • Work on sport/activity specific drills
  • prepare for a return to activity/sport

Finally, in the late stages of ACL rehabilitation, it is imperative we prepare our bodies for a return to normal pre-injury activity or sport. In fact, there will be a number of different physical components involved in the rehabilitation process during this phase.

This phase of rehabilitation will involve strength, power, single-leg symmetry, dynamic balance, agility drills, and sport/activity-specific tasks to target the specific goals of rehabilitation.

The exercises involved in each component will vary based on the individuals’ needs and the demands of their activity levels/sport, hence completing an individualised exercise program is so important during the recovery process.

Below are some examples of late-stage ACL rehabilitation exercises which target the different activity demands.

(Filbay & Grindem, 2019)


  • Back squat
  • Single leg drop + box jump
  • Alternating split squat jumps
  • Nordic curls
  • Single leg balance with reaction ball catch
  • Banded SL hops (Multidirection)
  • Running with cutting



  1. Filbay SR, & Grindem H. Evidence-based recommendation for the management of anterior cuciate ligament (ACL) rupture. Best Practice & Research Clinical Rheumatology. 2019;33:33-47.
  2. van Melick N, van Cingel REH, Brooijmans F, et alEvidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensusBritish Journal of Sports Medicine 2016;50:1506-1515.
  3. Dresendorfer R, & Watkins L. Anterior cruciate ligament reconstruction. Cinahl Information Systems. 2017.


Fit Clinic recommends seeking advice from a qualified health professional to provide an opinion before starting an exercise program for ACL rehabilitation.