ACL and Meniscus Injuries: Assessment and Rehabilitation

How ACL and meniscus injuries differ

The AAOS ACL injury guide explains that the anterior cruciate ligament helps control forward movement and rotation of the knee. An injury may cause a pop, swelling, loss of movement or a feeling of giving way.

The menisci are cartilage structures between the thigh and shin bones. AAOS meniscus guidance describes pain, swelling, catching or locking among possible symptoms. Symptoms overlap with other knee problems; they do not establish which structure is injured.

Tell the clinician how the injury happened, whether the knee locks or gives way and which tasks you cannot manage. Do not repeatedly provoke twisting or jumping to test the knee yourself.

Assessment and treatment decisions

Examination and history guide assessment, with imaging where indicated. An X-ray can investigate associated bone injury; MRI can help assess ligaments and the meniscus. Ask what a proposed scan is intended to clarify.

The AAOS ACL treatment overview considers instability, activity demands and associated injuries when discussing rehabilitation or surgery. The decision should be made with the treating clinician.

Meniscus options depend on symptoms and the tear. Non-operative care, repair and removal of damaged tissue are different approaches. A meniscus repair needs healing of the repaired tissue, so its restrictions can differ from a partial meniscectomy. Confirm what was done rather than using the word “arthroscopy” as a complete rehabilitation instruction.

Rehabilitation after reconstruction or meniscus surgery

The Aspetar guideline on rehabilitation after ACL reconstruction supports exercise progression informed by clinical findings as well as time since surgery. Associated injuries or meniscus procedures require the surgical team's instructions to be considered.

Ask the team to clarify weight-bearing, allowed bending, brace use and when each can change. Keep those instructions available at physiotherapy appointments. Goals may address movement, walking, strength and control, with exercises selected for the stage of your care.

• For each prescribed exercise: confirm its purpose, starting position, support and amount of practice.
• Before progressing: ask which findings must improve and whether medical clearance is needed.
• At review: report swelling, pain, giving way and changes in the everyday tasks you want to regain.

Our post-surgery rehabilitation guide explains discharge preparation, restrictions and follow-up questions.

Running and returning to sport are separate decisions

The Aspetar guideline considers knee symptoms, movement, strength, functional testing and psychological readiness. Its proposed return-to-sport criteria include recommendations for professional athletes; they are not a universal home checklist.

Ask which assessments fit your sport and level of participation. Beginning controlled running does not automatically mean readiness for pivoting, contact or competition. Time is relevant to healing, but the calendar alone does not establish readiness. Passing a test does not guarantee freedom from another injury.

See our sports injury recovery guide for planning a return to training with appropriate assessment and review.

When knee symptoms need urgent medical assessment

The NHS knee-pain advice recommends urgent help for a very painful or badly swollen knee, inability to move it or bear weight, locking or giving way, or fever with redness and heat around the knee. Do not wait for a routine exercise appointment.

After surgery, new pain and swelling in one calf or thigh also need urgent assessment for a possible blood clot. NHS DVT guidance advises emergency care if leg pain and swelling occur with breathlessness or chest pain. Follow the surgical team's other warning instructions.

Preparing for knee physiotherapy

Bring any diagnosis, imaging reports, operation notes and rehabilitation instructions. Explain your walking aids and assistance needs. Ask whether your examination and any later running or sport tests need an in-person appointment.

Our knee physiotherapy page describes assessment and exercise planning. If you have had an operation, the post-surgery service page explains preparation alongside the treating team's plan.

Does every meniscus tear need surgery?

No. Treatment depends on symptoms, the tear and the wider knee assessment. Discuss suitable options with the treating clinician.

Can I follow a friend's ACL exercise programme?

Your procedures and restrictions may differ. Have the physiotherapist check the movements against your own instructions before using that programme.