The anterior cruciate ligament (ACL) is a strong band of connective tissue inside the knee joint that connects the femur (thigh bone) to the tibia (shin bone). Its primary role is to help stabilize the knee by preventing excessive forward movement and rotation of the tibia. Unlike muscles, ligaments like the ACL are not designed to stretch, so they provide passive stability while the muscles and tendons control movement.

Most ACL injuries occur without direct contact. Common mechanisms include sudden deceleration, rapid pivoting, landing awkwardly from a jump, hyperextension, or twisting the knee with the foot firmly planted. A partial tear is often referred to as a sprain, while a complete tear is a rupture.

When deciding between surgical or conservative management of an ACL rupture, the best candidates for surgery tend to be younger, highly active athletes—especially those in sports involving pivoting and cutting movements. Surgery can restore knee stability and may reduce the risk of secondary damage like meniscal tears or cartilage wear that can eventually lead to osteoarthritis. However, it’s important to note that surgery is not a quick fix; post-operative rehabilitation often takes 9-12 months before an athlete can fully return to sport.

In contrast, most less-active individuals or older patients can respond well to conservative care. Long-term outcomes of surgery versus non-surgery tend to be similar for these patients, and non-surgical treatment avoids surgical risks and recovery time. Recent research also suggests that some full tears can heal with a structured rehabilitation program.

Conservative care is multimodal and tailored to the individual. Interventions may include bracing and activity modification to offload the knee; progressive exercises to restore strength, balance, and joint control; and manual therapies like mobilization, myofascial release, and trigger point therapy to improve mobility. Treatment may also address biomechanical issues elsewhere in the kinetic chain—such as foot pronation or hip weakness—that can contribute to knee instability.

Chiropractors, working alongside physical therapists, massage therapists, sports medicine doctors, and orthopedic specialists, are well equipped to support patients with ACL rupture. They can help them reduce pain, optimize knee stability, and achieve their personal goals, whether that’s returning to sport or carrying out their normal activities of daily living.