The primary goals post-operatively are the reduction of swelling and pain, and to normalise your walking pattern and patella mobility as soon as possible. The physiotherapist will prescribe exercises to regain knee extension and flexion within the first few days post-operatively. Full knee extension should be retained as early as possible, ideally within the first few weeks, and knee flexion should be regained fully within the first 6 weeks.

Quadricep activation exercises should start within the first few days post-operatively, progressing onto closed kinetic chain exercises at the knee between 0-60º. It is important that we do not solely focus on the knee joint and look to strengthen the entire lower limb including the glute, calf and hamstring with exercises focusing on muscle hypertrophy.

Cardiovascular training on a static bike can begin when 100º of knee flexion is achieved and neuromuscular training should begin in the first few weeks ^(8,9). Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.

In the later stages of rehabilitation, you will start to develop your single-leg multi plantar and multisegmental movements. This is important to develop as the role of your injured anterior cruciate ligament is to prevent multi-planar movements. Sports-specific rehabilitation should begin involving visual-motor training ⁽¹⁵⁾. Strength and power work must continue through the intermediate and advanced stages of rehabilitation, making sure there is the incorporation of exercises addressing the limb’s rate of force development. It is important to be strong and powerful but, as peak anterior cruciate ligament strain can be seen very early on in a movement (within less than a second), it is important that our muscles are not only strong but are able to react quickly to protect the ligaments from excessive pressures ⁽¹⁴⁾. Pain should not exceed 4/10 whilst completing this exercise programme.