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Rehab For ACL Deficiency
The ACL or Anterior Cruciate Ligament of the knee is commonly injured in sports.
In the illustration, you can see that the ACL attaches the femur and the tibia. The purpose of the ACL is to limit the amount of anterior translation of the tibia on the femur. If the ACL is ruptured, the lower leg bone may move abnormally on
the upper bone, causing the sensation of instability and knee buckling. The ACL can be partially or completely ruptured and may be surgical or non-surgical. If it is surgical, it may be beneficial to start a rehab program prior to surgery. This may speed up the recovery process after surgery. If it is not surgical at this time, your goal will be to maximize knee stability, while protecting the ACL so that you can safely tolerate your daily activities 
Things to keep in mind when training someone with the diagnosis of ACL Deficiency
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| Image 1 |
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| Image 2 |
In Image 1, you can see the quadriceps muscle inserts into the tibia as the patella tendon. Upon contracting the quads, the patella tendon will actually translate the tibia anteriorly. This is further stressing a partially torn ACL. In Image 2, you can see that the gastrocnemius crosses the knee joint and attaches to the femur posteriorly. When the calf muscle contracts, it translates the femur posteriorly, which is relative anterior translation of the tibia, which stresses the ACL yet again. Looking again to Image 1, the hamstring tendons are attached posteriorly to the tibia. Upon hamstring contraction, the tibia is translated posteriorly. This actually assists the ACL in its job of stabilizing the knee and minimizing anterior translation of the tibia on the femur. So, when training a client with ACL deficiency, your goal is to maximize knee joint stability, while minimizing stress on the ACL. You want to focus training on any weaknesses present and not neglect the quads or calf muscles. However extra attention to the hamstrings will pick up the slack of the deficient ACL.
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