Hein Viljoen
Physiotherapy
In the previous blog post, Understanding ACL Tears: What Happens and Why, we looked at what the ACL does, the two ways it tears and the symptoms to watch out for.
Tearing your ACL is only half the story, though — what determines how well you get back to the sport you love is the months of rehab that follow. That's where a multidisciplinary team comes in: your physiotherapist, biokineticist, and coach work together to close the gap between healing and being ready to perform.
Not every ACL tear means surgery. Depending on how your knee responds, how unstable it feels, and what you want to get back to, some tears are managed conservatively, with a rehab programme instead of reconstruction. Your physio helps you work out which path makes sense for you.
If you are heading for surgery, the work starts before the operation with prehab, short for prehabilitation. The aim is to go into surgery with a calm knee: swelling settled, full range of motion back, and your quads switched on and getting stronger.
How strong and mobile your knee is going into surgery is linked to how well it recovers afterwards. Studies suggest prehab can give strength and hop performance a small but real boost after the operation.
For years, ACL recovery ran on the clock: start running at three months, return to sport at nine. Now, rather than moving on because a certain number of weeks have passed, you move on when you can show your knee is ready.
That means being tested often. Strength in both legs, hop and jump tests, how you land and change direction, and how confident you feel in the knee are all measured, and the results decide when you progress.
A 2025 study from Aspetar in Qatar followed 530 male athletes in pivoting sports after ACL reconstruction. Those who completed rehab and met the objective discharge criteria were almost six times more likely to return to their pre-injury sport. And among those athletes, returning before or after the nine-month mark didn't change their risk of a new knee injury.
Still, other studies have linked returning before nine months with a higher re-injury risk. Time is necessary, but it isn't enough on its own.
So recovery time varies with whether you had surgery, how your body responds to rehab, and what you're getting back to — a competitive contact sport demands a longer, more rigorous return than recreational exercise.
In the first phase, whether you've had surgery or not, the goal is to calm the knee down and let it heal properly. At Hein Viljoen Physiotherapy, this stage focuses on three things: range of motion, recovery and pain management, and basic strength work.
Your physio helps manage the swelling and pain and works on getting your range of motion back, but not too fast and not too slow. Move too little and the knee can stiffen up; push too hard too soon, and you risk delaying the healing. Your quads also tend to switch off quickly after a knee injury, so a big part of early rehab is getting that muscle firing again. Relearning a normal walking pattern matters here too.
You're ready to move on when the knee is quiet, has full range of motion, and your quads are switching on properly.
Once the knee moves comfortably, the biokineticist takes the lead, and objective testing becomes a regular part of rehab. Biokineticist Werner Meyer of Meyer & Felton Biokinetics describes this stage as building an athlete, not just a stronger knee: developing the strength and capacity in the joint and surrounding tissue to handle what your sport will ask of it.
Load is added gradually, and your injured leg is regularly tested against your good one so nothing gets left behind. This is also when your knee relearns its sense of position — something the ACL normally helps with. Balance work and reactive drills help rebuild that, and regular testing picks up habits like favouring the other leg before they cause problems elsewhere.
From there, you work through a series of steps, and each one is earned by meeting the criteria for the last:
Return to sport and return to competition aren't the same thing: match play asks more of the knee, so it's tested and earned separately. Rushing the final stages is one of the biggest reasons people re-tear the same knee. That's why you decide to return together, based on what your knee can actually do, not how long it's been.
At Hein Viljoen Physiotherapy, we're with you at every stage of that process — from the first assessment through to being cleared for the sport you love. Book your appointment here to get started.
