Do You Really Need Surgery for an ACL Tear?
The Truth About Non-Surgical ACL Rehab
Tearing your ACL is a big moment—whether it happened on the footy field, while skiing, or during something as simple as stepping awkwardly off a curb.
One of the first questions people ask is:
“Do I need surgery to fix it?”
And while surgery can be the right choice for some, more and more research (and real-life experience) shows that non-surgical management can work really well—especially with the right physiotherapy and rehab plan.
Let’s walk you through what that looks like.
What Is the ACL—and What Happens When It Tears?
The ACL (anterior cruciate ligament) is one of the key ligaments that helps stabilise your knee—especially during twisting, pivoting, and changing direction.
When it tears, you might feel or hear a pop, followed by pain, swelling, and often the sense that your knee just “gave way.”
It sounds serious—and it is—but it doesn’t always mean you need to rush into surgery.
Can You Treat an ACL Tear Without Surgery?
In many cases, yes.
Recent studies show that non-surgical rehab—when done properly—can lead to strong, stable knees and full return to sport or work for many people.
A 2022 review in British Journal of Sports Medicine highlighted that structured rehab, combined with patient education and activity modification, can give comparable results to surgery in the long term for many individuals (Grindem et al., 2022).
Another 2023 trial found that around half of young, active people who started with physio first never needed surgery at all (Filbay et al., 2023). That’s huge.
So, Who’s a Good Fit for Non-Surgical Rehab?
Not everyone—but more people than you'd think.
You might be a good candidate for non-surgical ACL management if:
You’re not playing high-level pivoting sports (like soccer or netball)
You don’t have major damage to other structures in the knee (like the meniscus)
Your knee is stable and you’re not experiencing frequent giving way
You’re committed to a high-quality rehab program with a physio
Even if you do eventually decide on surgery, starting with physio first can improve your outcomes later.
What Does ACL Physio Involve?
Physio-led rehab for an ACL tear is structured, progressive, and tailored to your goals. It often includes:
Reducing swelling and regaining full range of motion
Building strength, especially around the quads and hamstrings
Balance, control, and single-leg stability training
Gradual return to walking, running, and sport-specific drills
Preventing re-injury with smart movement retraining
This isn’t just “rest and see how it feels”—it’s an active recovery, with your physio guiding every step.
Surgery Isn’t a Shortcut
Surgery can help in some cases—especially for elite athletes or people with unstable knees—but it’s not a quick fix.
Even if you have surgery, you’ll still need 9–12 months of physiotherapy to return to full function and reduce your risk of re-tearing.
That’s why we often recommend starting with rehab first. You may be surprised how well your knee recovers without going under the knife.
Final Thoughts
ACL injuries can be scary, but surgery isn’t always the only (or best) path forward. With the right guidance, support, and commitment, many people recover fully with a conservative approach.
If you’ve just injured your knee and aren’t sure what to do next—don’t rush into decisions. Let’s assess your knee properly, talk through your goals, and build a plan that works for you.
Let’s Figure It Out Together
At Thrive Physio, we’ve helped patients of all ages and activity levels recover from ACL injuries—both with and without surgery. If you want honest advice and a clear path forward, book in with one of our experienced physios today.
We’ll help you move forward—one step at a time.
