ACL injury
An injury to the anterior cruciate ligament (ACL), often caused by a rapid change of direction, landing or twisting movement. The injury may be partial or complete and can affect knee stability.
A minor or partial ACL injury may cause local pain, tenderness and limited swelling. Stability may be relatively preserved, but symptoms alone cannot determine the extent of the injury.
ACL injuries often occur when the foot is planted while the knee is exposed to rotation, rapid deceleration or a combination of rotation and valgus loading. In football, this may happen during a rapid change of direction, landing after an aerial challenge or sudden deceleration.
Common situations
- •Rapid change of direction with the foot planted
- •Poorly controlled or awkward landing after a jump
- •Sudden deceleration or acceleration
- •Twisting or collision with the knee under load
Risk may be reduced through regular training of leg strength, trunk and hip control, and neuromuscular control during landing, deceleration and changes of direction.
- •Train strength in the thighs, hips and trunk
- •Practice controlled landings and decelerations
- •Practice changes of direction with good knee control
- •Increase training and match load progressively
Stop football activity and avoid movements that provoke pain or instability. Reduce load as needed and use symptom-relieving measures appropriate for the individual.
Restore mobility and control
Focus on restoring knee range of motion, reducing residual swelling and re-establishing good control.
Goals
Good range of motion, low symptom levels and good basic leg control.
Progression criteria
Able to perform daily activities and basic exercises without significant pain, swelling or instability.
Build strength and function
Progressive training of leg strength, hip and trunk control, and knee control.
Goals
Restore the strength and control required for football demands.
Progression criteria
Good control during single-leg exercises, jumping and progressively more football-specific movements.
- No or minimal residual swelling
- Good range of motion
- Adequate strength and single-leg control
- Able to tolerate progressively increasing running, jumping and changes of direction
- Able to complete football-specific testing without significant pain or instability
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
ACL injury
An injury to the anterior cruciate ligament (ACL), often caused by a rapid change of direction, landing or twisting movement. The injury may be partial or complete and can affect knee stability.
Mild — Partiella skador kan ta veckor till flera månader beroende på skadans omfattning och funktion. Återgången bör styras av funktion och medicinsk bedömning snarare än en fast tidsperiod.
Symptoms
A minor or partial ACL injury may cause local pain, tenderness and limited swelling. Stability may be relatively preserved, but symptoms alone cannot determine the extent of the injury.
Acute Treatment
Stop football activity and avoid movements that provoke pain or instability. Reduce load as needed and use symptom-relieving measures appropriate for the individual.
Rehabilitation
Focus on restoring knee range of motion, reducing residual swelling and re-establishing good control.
Goals
Good range of motion, low symptom levels and good basic leg control.
Progression criteria
Able to perform daily activities and basic exercises without significant pain, swelling or instability.
Progressive training of leg strength, hip and trunk control, and knee control.
Goals
Restore the strength and control required for football demands.
Progression criteria
Good control during single-leg exercises, jumping and progressively more football-specific movements.
Return to Play
- ☐ No or minimal residual swelling
- ☐ Good range of motion
- ☐ Adequate strength and single-leg control
- ☐ Able to tolerate progressively increasing running, jumping and changes of direction
- ☐ Able to complete football-specific testing without significant pain or instability
Moderate — Återhämtningen kan ta flera veckor till flera månader. Vid bekräftad ACL-skada behöver tidsförlopp och behandling planeras individuellt.
Symptoms
More pronounced pain, swelling and reduced function may occur. The player may feel that the knee is unstable, especially during running, changes of direction or other loaded movements.
Acute Treatment
Stop play and training. Avoid loading that causes pain or instability and have the injury assessed by a healthcare professional, particularly when there is significant swelling or instability.
Rehabilitation
Reduce swelling and pain and restore as much normal knee mobility as possible.
Goals
Good range of motion and improved daily function.
Progression criteria
Able to walk and tolerate basic loading without significant worsening.
Progressive strength and control training adapted to the extent of the injury.
Goals
Restore good strength, balance and control.
Progression criteria
Able to tolerate single-leg loading, jumping and running with good control and without significant post-exercise reaction.
Return to Play
- ☐ No significant swelling after training
- ☐ Good range of motion
- ☐ Adequate strength compared with the unaffected side
- ☐ Good control during jumping, landing and changes of direction
- ☐ No perceived instability during football-specific movements
- ☐ Individual medical assessment before full return
Severe — Efter ACL-rekonstruktion är återgång till fotboll ofta en process på cirka 6–12 månader eller längre. Tidsförloppet varierar och bör styras av funktion, rehabiliteringsmål och medicinsk bedömning.
Symptoms
A more severe ACL injury may cause rapid and significant swelling, marked loss of function and a feeling that the knee gives way. Meniscal, cartilage or other ligament injuries may occur at the same time.
Acute Treatment
Stop all sports activity and seek medical assessment. Reduce weight-bearing as needed and do not force the knee through painful or unstable movements.
Rehabilitation
The extent of the injury and any associated injuries are assessed. Rehabilitation begins with a focus on swelling, range of motion, strength and function.
Goals
Restore basic knee function and establish a foundation for continued rehabilitation.
Progression criteria
Good range of motion, controlled swelling and sufficient strength for the next rehabilitation level.
Strength, jumping, running, deceleration and changes of direction are progressively reintroduced. Following reconstruction, an individualized postoperative program is used.
Goals
Restore the strength, control and load tolerance required for football.
Progression criteria
Able to complete relevant strength, jumping and football-specific tests without pain, significant swelling or instability.
Return to Play
- ☐ Good range of motion
- ☐ No significant residual swelling
- ☐ Adequate strength and neuromuscular control
- ☐ Good function during jumping, landing, acceleration, deceleration and changes of direction
- ☐ Able to complete football-specific testing and progressively tolerate full training load
- ☐ Medical assessment and an individualized return-to-play plan
When to Seek Medical Care
A suspected ACL injury should be assessed by a healthcare professional, particularly after a clear twisting injury with rapid swelling or perceived instability.
- Significant swelling after the injury
- A feeling that the knee gives way
- Recurrent instability
- Inability to bear weight normally
- Locking or suspected associated meniscal or cartilage injury
References
- ACL Injury – Does It Require Surgery? — American Academy of Orthopaedic Surgeons (https://orthoinfo.aaos.org/en/diseases--conditions/acl-injury-does-it-require-surgery/)
- Aspetar — Aspetar (https://www.aspetar.com/en)