What Good ACL Care Looks Like: An Evidence-Based Roadmap From Injury to Long-Term Health

When someone tears their ACL, the first question is usually "when is surgery?" This review by Filbay and Grindem — two prominent researchers in ACL care — takes a step back and summarises what the overall body of evidence says about managing an ACL rupture from day one through the years that follow.

The authors describe ACL rupture as an injury that mostly affects young, active people and that can have negative long-term physical and psychological impacts, including an increased risk of developing knee osteoarthritis. They frame management around four objectives: restoring knee function, addressing psychological barriers to activity, preventing further knee injury, and optimising long-term quality of life.

A key message is that surgery is not the only evidence-supported pathway. The review discusses both management with structured rehabilitation alone and ACL reconstruction followed by rehabilitation, and emphasises that the choice should be made through informed, shared decision-making that considers the person's goals, activity demands, and knee symptoms. Whichever pathway is chosen, the authors describe rehabilitation that is organised into phases, with progression based on meeting specific criteria — such as regaining motion, strength, and control — rather than simply waiting a set number of weeks. They also highlight the importance of exercise-based rehabilitation, patient education, and attention to psychological readiness throughout.

For patients, the practical takeaway is that high-quality ACL care is a process measured in months, guided by milestones, and tailored to the individual — and that a well-run rehabilitation program is essential whether or not surgery is part of the plan. Asking your care team how your progress will be measured, and what criteria you need to meet before each new phase, is exactly in line with what this review recommends.

Key findings

• ACL rupture most commonly affects young, active people and can have lasting physical and psychological impacts, including a raised risk of knee osteoarthritis.
• The goals of management are to restore knee function, address psychological barriers, prevent further injury, and optimise long-term quality of life.
• Treatment options include structured rehabilitation alone, or ACL reconstruction plus rehabilitation; the review discusses evidence for both pathways rather than surgery being automatic.
• Rehabilitation should be goal-driven and progress through phases based on meeting criteria, not just time elapsed.
• Patient education and shared decision-making are central to choosing a management pathway.

Clinical relevance

It provides the evidence-based framework a multidisciplinary team works from: criterion-based phases, exercise therapy, education, and attention to long-term joint health rather than a one-size-fits-all surgical timeline.

Prepared by the Volt Health team as an educational summary of the cited publication. It is not medical advice; assessment and treatment decisions should always be made with a qualified health professional.