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Anterior cruciate ligament (ACL) injuries are among the most common knee injuries, particularly in people who participate in sports such as soccer, basketball, and football.

Three bones, the thigh bone, shin bone, and kneecap, form the knee joint and those bones are connected by collateral and cruciate ligaments. The collateral ligaments are on the sides of the knee, while the cruciate ligaments form an “X” inside the joint. The front of the X is the anterior cruciate ligament and the posterior ligament is the back of X.

The ACL is in the middle of the knee and gives it stability during rotations. It can be injured when a person changes direction suddenly, stops suddenly, lands badly from a jump, as a person slows down from a run, or due to direct contact.

Not all ACL injuries require surgery, but some do. In many cases of ACL injury, the ligament and a piece of bone become separated from the rest of the bone, an injury called an avulsion fracture.

When surgery is necessary, the ACL must be rebuilt through a tissue graft, because the ligament can’t be repaired with stitches. The tissue for the graft can come from several sources, and Dr. Nickson at Next Step Orthopedics discusses the options with all of his patients within the context of their individual situations.

Most often the graft is from your own body. The patellar tendon and hamstring tendons are commonly used. Following surgery, the new tissue must grow, so healing takes time. There are several things that can help you recover smoothly.

Physical therapy

A physical therapy program designed specifically for you will help you recover function, mobility, and strength. Some therapy programs begin before surgery to prepare the knee.

Following surgery, rehabilitation will progress as the knee heals. Most likely, in the first week, you’ll need to ice and elevate the knee to reduce swelling. Being able to extend the knee fully and flex it to 70 degrees are common first-week goals.

By the fourth and fifth months after surgery, you will be working to maximize the strength and stability of the knee, as well as doing exercises specific to your life.

Adhering to the physical therapy program is one of the most important things you can do to ensure a proper and speedy recovery.


A 2014 review of previously conducted studies showed that cryotherapy, the use of extremely cold temperatures, within 48 hours following surgery can reduce pain. The use of compression, by wrapping with a bandage or using a compression sleeve, and cryotherapy can be particularly effective.


Not every patient requires bracing following ACL surgery, and some need a brace in the first few weeks following surgery while others need a brace during activity for as long as a year or two after surgery. Dr. Nickson recommends bracing for patients on a case by case basis.


Waiting to heal is never fun, and you’re an athlete who longs to return to your normal activities, it can be especially difficult. However, adequate rest is an essential part of a full recovery.

The tissue graft needs time to grow, and then it takes more time to regain strength, flexibility, and stability. Following Dr. Nickson’s instructions, adhering to your physical therapy program, and utilizing the appropriate strategies will help you recover as quickly and fully as possible.

Call us at (972) 547-0047 or book an appointment online.

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