Massage therapy · Kitchener–WaterlooAnterior Cruciate Ligament Rupture and Reconstruction
Knee
What It Is
The anterior cruciate ligament (ACL) is one of four major stabilising knee ligaments. It connects the femur (thigh bone) to the tibia (shin bone) and helps your knee move and stay stable (NHS, 2025a). The ligament is a very important part of the knee joint. Injuries can occur from a bad tackle during football or rugby, a sharp sudden twisting movement or a quick change of direction. It can also be damaged by jumping and landing awkwardly.
Most ACL injuries are complete or near-complete tears (ruptures); partial tears are rare (AAOS, n.d.). At first your knee will usually be swollen and stiff, and walking may be difficult. As the weeks go by, walking usually improves and the swelling reduces. After a complete tear, some people find their knee feels loose or gives way during everyday activities such as walking, others only notice this during sports that involve pivoting or sharp turns, and a few have no feeling of instability at all (AAOS, n.d.).
Not all ACL injuries need surgery. For some people, physiotherapy and rehabilitation, sometimes with a knee brace, can restore the knee close to how it was before the injury (AAOS, n.d.). I can support this rehabilitation alongside your physiotherapist. Surgery may be recommended if you play a lot of sport and want to continue, or if you keep having problems with your knee after trying physiotherapy (NHS, 2025a). This is a decision to make with your orthopaedic surgeon.
Not a diagnosis — for more information, contact me or another trusted healthcare provider.
Treatment
Self-Care & Treatment
Surgical Options
Patellar Tendon Graft
Hamstring Tendon Graft
Quadriceps Tendon Graft
The quadriceps tendon sits just above the kneecap. Part of the tendon is taken, with or without a small plug of bone from the kneecap. In the past this graft was mainly used when a previous ACL reconstruction had failed, but it is now increasingly used for first-time reconstructions and can be taken through a small incision (Ostojic et al., 2024). As with the patellar tendon graft, there is a small risk of kneecap fracture (AAOS, n.d.).
Tips for Recovery/Rehabilitation
Treatment
My Approach
After an ACL injury or reconstruction, your surgeon and physiotherapist set the plan: how much weight you can take, whether you need crutches or a brace, and which movements are allowed and when. I work inside those limits. After surgery, I need your surgeon's okay before we start any hands-on treatment. If you're managing the injury without surgery, I work alongside your physiotherapist's programme in the same way. The ligament sits too deep in the knee to reach, so my work is on everything around it.
Early Weeks
- Massage for your back, hips and other leg, and your shoulders and arms if you're on crutches
- Gentle lymphatic drainage above the knee to help with swelling, and raising the leg when you can
- Supporting the gentle knee and thigh exercises your physiotherapist gives you
As It Heals
- Hands-on work for the thigh, hamstrings and calf to ease tightness that limits straightening and bending
- Gentle kneecap mobilisation to stop the tissue around it stiffening
- Scar work once the incisions have fully healed, including where the graft was taken
- Strength and balance work that matches your physiotherapist's stage, such as squats in safe ranges and step-ups
Later Rehab
What to Expect
Typical Course
What I Focus On
Please read
When to See a Doctor First
When to Get Urgent Help
A blood clot in a vein of the leg (deep vein thrombosis, or DVT) is a rare but potentially serious complication of ACL surgery (AAOS, n.d.). Throbbing pain and swelling in one leg, usually in the calf or thigh, with red or darkened skin around the painful area, can be signs of a DVT; contact your surgical team or doctor urgently, the same day (NHS, 2026). If you have these symptoms and also feel short of breath or have chest pain, call 911 or go to the emergency room at your nearest hospital, as the clot may have travelled to your lungs (NHS, 2026).
Sources
References
- NHS (2025a) What is ACL (anterior cruciate ligament) surgery?. Available at: https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/what-it-is/ (Accessed: 8 October 2026).
- NHS (2025b) How ACL (anterior cruciate ligament) surgery is done. Available at: https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/how-its-done/ (Accessed: 7 October 2026).
- NHS (2025c) Recovering from ACL (anterior cruciate ligament) surgery. Available at: https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/recovering/ (Accessed: 7 October 2026).
- American Academy of Orthopaedic Surgeons (n.d.) ACL injury: does it require surgery?. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/treatment/acl-injury-does-it-require-surgery/ (Accessed: 7 October 2026).
- Ostojic, M. et al. (2024) 'Graft selection in anterior cruciate ligament reconstruction: a comprehensive review of current trends', Medicina (Kaunas), 60(12), p. 2090. doi: 10.3390/medicina60122090
- NHS (2026) DVT (deep vein thrombosis). Available at: https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/ (Accessed: 8 October 2026).