What is the presenting case?

Ky presented to the clinic following a knee injury playing football on the weekend. He had gotten
tangled up in a tackle and landed awkwardly on his knee, hearing an audible pop as he went
down. He was not able to continue playing, he took himself to get an x-ray which showed no
Ky had no other prior knee injuries and had just come off the back of a solid pre season
where he was feeling strong and fit.

Clinical Findings:

Ky came into the clinic 5 days post injury. He was able to weight-bear through the affected side
but still had significant swelling around the knee globally. He was having some pain at night time
and was feeling stiff and sore first thing in the morning.

  • Posterior draw and sag: negative due to lack of PCL injury
  • Anterior draw and Lachman’s test: positive and lax due to ACL injury
  • McMurray’s test: negative and not painful due to lack of meniscus injury
  • Valgus and Varus stress tests: negative with firm end feels due to lack of collateral ligament
  • Swelling was obvious globally through the knee and he had a positive patella tap and swipe
    test, this is indicative of swelling both inside and outside the knee joint capsule
  • Reduced knee range of motion due to the swelling

Clinical Diagnosis:

ACL tear with or without bony bruising

What was the end goal?

Play league football again


Initially, we had to refer Ky for further imaging of his knee to confirm my suspected clinical
diagnosis. This is best done via MRI. Unfortunately for Ky, the diagnosis of an isolated ACL tear,
with no collateral or meniscal injuries, was confirmed which meant he was in for a long road to
recovery and return to sport.

When it comes to isolated ACL injuries, there are two pathways that can be taken: surgical or
conservative management. These are big decisions that are best attacked with a team involving:
the athlete, sports physician, surgeon and physio. In discussion with the aforementioned team, Ky decided to go ahead with surgery, this was due to a variety of factors and everyone on the team
was in agreement.

Prior to these types of surgery at Elite Physio we undergo a battery of pre-surgery strengthening
exercises as well as strength, functional and muscle capacity testing. This ensures that post surgery
we are able to compare where the athlete is at and where we need to get them back to
and beyond.

Ky was extremely diligent with his prehab program which meant that he was as strong as he
could be prior to his operation. Having athletes and clients being strong prior to surgery leads to a
better outcome afterwards. In the recovery phase immediately post surgery it is natural to have a
loss in muscle strength. Therefore, the stronger you are beforehand, the less of a gap there is to
bridge afterwards.

The return to play timeframe post ACL reconstruction surgery is a minimum of 12 months. That is
a long time!! In order to not get lost in that timeframe, we broke Ky’s recovery and rehab process
into 6 week blocks. In each block there were mini goals to achieve in order to progress into the
next block of rehab. This is a long and often tedious process however, in order to play football
again it is important to be diligent and strict with this process.
To ensure that we remain on track and are achieving those mini goals we continually re-perform those strength, functional and muscle capacity tests.

Once we are happy with his strength and muscle capacity, Ky progressed through return to
running programs, hopping, landing, change of direction and agility drills. Then Ky was able to
participate in modified training and progress into full football training with no contact and finally
full training with contact and into match simulation. This is over a period of approximately 3
months. Ky then participated in full training with contact for approximately 4 weeks until we were
both happy with his confidence and capacity. Following that Ky was cleared to return to play. A
huge effort and fantastic outcome!!


Following a long period of strenuous rehab and training Ky was able to confidently return to play
league football. Ky will have ongoing prevention strategies integrated into his training and will
need to ensure to stay on top of strength work outside of football training. All aimed to mitigate
the risk of a second ACL injury.

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