ACL Injury and Rehabilitation
Table of Contents
What the ACL is
The anterior cruciate ligament (ACL) connects the femur and tibia inside the knee joint and is responsible for preventing forward translation of the tibia and providing rotational stability. It tears when excessive valgus and rotational force is applied during sudden direction changes or landing in sports such as soccer, basketball, or skiing. At the moment of injury patients feel a popping sensation, and the joint typically swells significantly within hours.
Diagnosis — Lachman test and MRI
The Lachman test is positive when the tibia is pulled forward with the knee flexed 20–30 degrees and the end point feels soft. The anterior drawer and pivot shift tests are also performed, and MRI distinguishes complete from partial tears. With ACL injury, accompanying damage to the medial meniscus or medial collateral ligament (the "unhappy triad") must always be evaluated.
The risk of giving way
If daily activities continue with a torn ACL, episodes of sudden buckling — known as giving way — recur. Each episode causes secondary damage to the meniscus and joint cartilage, accumulating into early osteoarthritis. For active patients, reconstruction surgery is therefore recommended.
Postoperative Korean medicine rehabilitation protocol
- Weeks 1–2 (acute phase): Managing surgical-site swelling is the top priority. Acupuncture (Xuehai, Yanglingquan) and herbal medicine (Dangguisu-san) clear blood stasis and reduce swelling rapidly.
- Weeks 3–6 (protection phase): Chuna manipulation is used to induce patellar gliding for restoring range of motion (ROM), and quadriceps setting exercises are started.
- Weeks 7–12 (strengthening phase): Pharmacopuncture prevents adhesions around the graft, and the quadriceps-to-hamstring strength ratio is restored to a normal level (60% or higher).
- Months 4–6 (return-to-play preparation): Tonic herbal medicine (deer antler, Achyranthes) supports graft maturation, and sport-specific movements (cutting, pivoting) are trained in stages.
Core principles of rehabilitation
Half of surgical success depends on rehabilitation. Returning too quickly raises the risk of re-tear, while excessive rest leads to joint adhesions and muscle atrophy. Combining Korean medicine treatment with exercise rehabilitation achieves pain control and tissue recovery simultaneously, which can shorten the time to return.