Anterior cruciate ligament injury
An anterior cruciate ligament (ACL) injury can also be treated without surgery in selected patients. Conservative treatment does not mean rest or waiting, but active, structured, and progressive rehabilitation. During the treatment, particular attention is paid to the functional stability of the knee and whether the patient can safely return to their desired level of activity.
Conservative treatment is a viable option, especially when the knee is functionally stable and does not experience recurrent giving way or slipping.
In the early stages of the injury, it is not possible to predict with certainty who will maintain a functionally stable knee. However, certain factors can increase the likelihood of success with conservative treatment.
• the knee appears relatively stable in the clinical examination
• no recurring giving-way episodes occur during rehabilitation
• the patient is slightly older
• the sport does not involve a high amount of change-of-direction and rotational loading
• muscle strength and motor control recover well
• sport-specific loading can be increased without symptoms of instability
Individual young athletes can also return to pivoting sports without surgical treatment. In this case, the prerequisite is that the knee remains stable under gradually increasing sport-specific loading and the athlete meets the criteria of the Return to Play assessment.
The success of conservative treatment is not determined by age or sport alone. The deciding factor is whether the knee can function stably under the load to which the patient wishes to return.
Conservative treatment should not be understood as passive monitoring or a predetermined waiting period.
The treatment is carried out systematically under the supervision of an orthopedist specializing in knee injuries and a physiotherapist specializing in ACL rehabilitation.
Fysioterapeutti Marko Kinnunen
In the initial phase, the goal is to:
• reduces swelling
• restore full knee extension and range of motion
• activate the hamstring and quadriceps muscles
• restore normal walking and basic movement control
After this, training is gradually increased.
Power →
balance and body control →
running →
jumps →
changes of direction →
sport-specific training
The scientific evidence for conservative treatment is based on intensive and long-term rehabilitation. For example, in Frobell's randomized controlled trial, patients in the rehabilitation groups had an average of more than 50 rehabilitation visits during the first two years.
Conservative treatment does not mean a few physiotherapy visits and waiting, but rather long-term active rehabilitation.
The most important aspect to monitor in conservative treatment is the functional stability of the knee.
If, despite rehabilitation, the knee repeatedly gives way or slips out of place, especially during changes of direction and pivoting movements, the treatment approach will be reassessed.
Repeated instability episodes predispose to new meniscus tears and other secondary injuries, which can have a significant impact on the long-term prognosis of the knee.
Rehabilitation is not a predetermined waiting period. During it, it is determined whether the knee can function stably at the activity level targeted by the patient.
The risk profile of a young person playing football, handball, basketball, floorball, or another sport with intense changes of direction with a goal-oriented approach is different from that of, for example, an adult returning to running or cycling.
If the young athlete's knee remains functionally stable and rehabilitation progresses as planned, conservative treatment can be continued.
If, on the other hand, recurrent functional instability occurs, there is no justification for continuing treatment solely to reach a predetermined time limit.
Conservative treatment does not end on a specific calendar date.
Return to exercise and sports is based on functional recovery.
The evaluation takes into account:
• muscle strength
• knee stability
• functional performance
• quality of movement
• psychological readiness
• sport-specific load tolerance
Active rehabilitation →
progressive overload →
sport-specific training →
Return to Sport
The goal is not just a symptom-free knee, but a knee that functions stably and reliably at the patient's desired level of activity.