Case Scenerio ACL Tear Rehabilitation

🩺 Case Scenario: ACL Tear Rehabilitation in a 22-Year-Old Football Player



Patient Profile

  • Name: M.A. (initials only)

  • Age: 22 years

  • Gender: Male

  • Occupation: University student & football player

  • Medical History: No previous surgeries, non-smoker, no comorbidities

Presenting Complaint

M.A. reports severe pain and swelling in the right knee after landing awkwardly during a football match. He describes a “popping sound” at the time of injury, followed by instability while walking.

 Initial Examination & Findings

  • Observation: Swelling around the right knee joint, antalgic gait.

  • Palpation: Tenderness at medial aspect of the knee.

  • Range of Motion (ROM): Painful & limited flexion beyond 90°.

  • Special Tests:

    • Lachman’s Test → Positive

    • Anterior Drawer Test → Positive

  • MRI Report: Complete tear of the Anterior Cruciate Ligament (ACL).

Diagnosis: Right ACL Tear (post-traumatic, sports-related).

 Physiotherapy Management Plan

🔹 Phase 1: Acute Phase (0–2 Weeks)

Goals: Reduce pain, swelling, and maintain ROM.

  • Rest, Ice, Compression, Elevation (RICE).

  • Isometric quadriceps sets.

  • Ankle pumps to improve circulation.

  • Gentle passive knee extension (avoid hyperextension).

  • Crutch-assisted walking, weight-bearing as tolerated.

🔹 Phase 2: Subacute Phase (2–6 Weeks)

Goals: Restore ROM and improve muscle activation.

  • Heel slides (flexion exercises).

  • Stationary cycling with low resistance.

  • Straight leg raises in multiple planes.

  • Patellar mobilizations to prevent stiffness.

  • Begin closed-chain exercises (mini squats, step-ups).

🔹 Phase 3: Strengthening Phase (6–12 Weeks)

Goals: Regain quadriceps & hamstring strength, improve stability.

  • Resistance band exercises for hamstrings & hip muscles.

  • Leg press (light weight, controlled movement).

  • Proprioception training (single-leg stance, wobble board).

  • Gradual progression of functional activities.

🔹 Phase 4: Advanced Training Phase (3–6 Months)

Goals: Return to sport-specific drills.

  • Plyometric training (box jumps, side hops).

  • Agility drills (zig-zag runs, shuttle runs).

  • Sport-specific movements (kicking practice under supervision).

  • Continue strengthening & flexibility exercises.

🔹 Phase 5: Return to Sport (6–9 Months)

Goals: Full recovery and safe return to competitive football.

  • Functional testing (hop test, agility test).

  • Return-to-play protocol after clearance from orthopedic surgeon & physiotherapist.

  • Injury prevention program (warm-up drills, neuromuscular training).

 Progress Notes

  • Week 1: Swelling reduced, patient able to walk with crutches.

  • Week 4: Improved ROM (0–120°), quadriceps activation achieved.

  • Week 8: Patient performing closed-chain strengthening & balance training.

  • Week 16: Jogging on treadmill, no instability.

  • Month 6: Passed functional tests, returned to practice sessions.

 Discussion & Learning Points

  • Early mobilization prevents stiffness and speeds recovery.

  • Closed-chain exercises are safer for ACL rehab than open-chain in early stages.

  • Proprioception & balance training are as important as strength training.

  • Gradual progression → avoids re-injury.

 Key Takeaway for DPT Students

“ACL rehabilitation is not just about strengthening the quadriceps. It is a step-by-step process that restores mobility, stability, proprioception, and confidence. Always individualize the rehab plan based on the patient’s progress.”


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