ACL Rehabilitation in Bradford - Clinical Progression of a 28-Year-Old Male Patient

Clinical Background & Mechanism of Injury

Our specialist ACL Rehabilitation in Bradford: The patient, a 28-year-old male, presented to our clinic following a twisting injury to his right knee. He sustained the injury while stepping out of a hot tub, where the foot slipped, and the knee rotated forcefully, resulting in an immediate audible pop. Rapid swelling occurred within hours, accompanied by difficulty fully weight-bearing and straightening the knee.

From a clinical standpoint, his symptoms raised early suspicion of an ACL (anterior cruciate ligament) rupture. The mechanism of injury was consistent with a rotational, non-contact event, which is typical of ACL involvement. The patient reported a feeling of instability, describing the knee as “giving way”, which is a hallmark sign of ACL deficiency.

Early symptoms included:

• Significant swelling around the joint

• Loss of terminal extension

• Difficulty weight bearing with a normal gait

• Loss of quadriceps activation

• Sensation of instability

Given his age, daily activity requirements, and the severity of symptoms, a thorough assessment was required to determine structural involvement and guide early management.

Assessment, Clinical Testing & Diagnosis

During the initial physiotherapy assessment at Apex Physiotherapy, his right knee demonstrated:

• Visible joint effusion

• Reduced flexion and notable loss of full extension

• Marked quadriceps inhibition

• Pain on end-range movement

Special tests, including the Lachman test and anterior drawer test were performed. Both showed clear anterior translation compared with the unaffected knee, suggesting ACL insufficiency. Due to the presence of swelling, a repeat test was performed in a follow-up session to confirm the clinical picture.

MRI imaging was arranged through the appropriate referral pathway. Findings were as follows:

• Complete rupture of the ACL

• No significant meniscal tear

• No collateral ligament damage

• Articular surfaces intact

Given his instability, functional limitations, and desire to return to physical activity, surgical reconstruction was recommended.

Prehabilitation Strategy & Rationale

Before ACL surgery, prehabilitation plays a crucial role in long-term outcomes. Evidence consistently shows that patients entering surgery with good quadriceps strength, minimal swelling, and a near full range of motion have significantly better postoperative recovery.

Objectives of the prehabilitation plan:

• Restore full knee extension

• Reduce joint swelling

• Improve quadriceps and hip strength

• Normalise gait pattern

• Maintain cardiovascular fitness where possible

Interventions included:

• Low load long duration stretching for extension

• Neuromuscular electrical stimulation (as appropriate)

• Quadriceps activation drills

• Stationary cycling for range and circulation

• Closed chain strengthening

• Early balance and proprioception tasks

Over several weeks, the patient achieved full extension, improved flexion, symmetrical gait, and strong quadriceps activation. This placed him in an ideal position for reconstructive surgery.

Early Post Operative Rehabilitation, 0-6 Weeks

Our postoperative rehabilitation in Bradford focused primarily on graft protection, early movement, and neuromuscular control. Maintaining extension is critical during this stage to prevent long-term deficits.

Key goals during this phase:

• Control swelling

• Restore full extension promptly

• Gradually increase knee flexion within surgical guidelines

• Re-establish quadriceps activation

• Begin early closed chain work

Methods used:

• Cryotherapy and swelling management

• Patellar mobilisation to prevent stiffness

• Heel slides and active assisted flexion

• Early straight leg raises with technique emphasis

• Sit to stand practice within tolerance

By the end of Week 6, he had full passive extension, improving flexion, and a normalised gait pattern. His quadriceps control had progressed sufficiently to allow return to work between Weeks 6 and 8.

Middle Phase Rehabilitation, 6-12 Weeks

This stage focused on restoring limb symmetry, building progressive lower limb strength, and enhancing neuromuscular control.

Clinical priorities:

• Achieve full knee flexion

• Improve strength in quadriceps, hamstrings, glutes, and calves

• Develop single-leg stability

• Begin low-impact cardiovascular conditioning

Interventions:

• Leg press with progressive loading

• Step downs to target eccentric control

• Lunges and split stance variations

• Single-leg balance and proprioceptive drills

• Cycling and cross-trainer sessions

The patient adhered closely to his plan. By Week 12, strength and control had progressed to a level suitable for gym reintroduction under guided supervision.

Advanced Functional Phase, 3-6 Months

This phase is essential for bridging the gap between basic rehabilitation and functional readiness.

Treatment goals:

• Improve multi-directional stability

• Increase strength and endurance

• Introduce controlled plyometrics

• Enhance movement quality

Progressions included:

• Weighted squats and deadlifts as tolerated

• Lunges with increased range and control

• Step downs from higher platforms

• Small hops, focusing on landing mechanics

• Agility-based drills were introduced cautiously

During this phase, emphasis was placed on correcting compensations and developing equal loading through both limbs.

Final Stage Rehabilitation, 6-12 Months

The final phase focused on confidence, higher intensity loading, and a safe return to running and recreational activity.

Key components:

• Advanced balance and proprioceptive work

• Running reintroduction using walk-run progressions

• Progressive loading through compound lifts

• Higher-level impact training in controlled environments

By Month 11, the patient was completing steady state runs, performing strength training independently, and demonstrating excellent single-leg stability.

Clinical Outcome Summary

At 11 months post-surgery, the patient achieved:

• Full and symmetrical knee range of motion

• Strong quadriceps and hamstring activation

• No residual swelling

• No instability or episodes of giving way

• Full return to running and gym activity

• Excellent knee confidence and function

His strategic ACL rehabilitation in Bradford was designed to implement consistent adherence, strong engagement with the programme, and a disciplined approach to each phase.

Physiotherapist’s Perspective

From a clinical standpoint, this case demonstrates the importance of structured rehabilitation, patient education, and progressive loading. The patient’s outcomes were strongly influenced by:

• High quality prehabilitation

• Consistency with home exercises

• Clear understanding of recovery milestones

• Gradual exposure to increased load

• Close monitoring of movement patterns

ACL reconstruction rehabilitation is a long-term process requiring patient commitment and clinician expertise. His successful return to running highlights what can be achieved through evidence based rehabilitation, clear communication, and phased progression.

If you require ACL rehabilitation in Bradford or the nearby areas, speak to our experienced professionals today.