Nonsurgical ACL Tear or Injury Treatments

The anterior cruciate ligament (ACL) is an important ligament in the knee that stabilizes and connects the thighbone to the shinbone. An ACL injury is a sprain or tear of this ligament, and it often occurs when playing sports or during a fall.

ACL injuries can be treated with or without surgery, depending on the type and severity of the injury. If you have a minor ACL injury, your doctor may suggest nonsurgical ACL injury treatment.

Nonsurgical approaches may also be best for:

• Older adults.
• People at a higher risk of surgery complications.
• Those resorting to a lower level of activity following injury, such as biking and walking, rather than high-impact activities, such as running.

UPMC specializes in both nonsurgical and surgical care for ACL injuries. By understanding your symptoms, lifestyle, and goals, we can recommend the best treatment plan for you.

What Is Nonsurgical Therapy for ACL Injury?

Immediately after an ACL injury, it's important to rest and reduce swelling to reduce the risk of damage to other parts of your knee joint. Reducing swelling is key, whether you need nonsurgical or surgical treatment.

After your swelling goes down, you can start exercises to strengthen the muscles that support your knee.

Types of nonsurgical ACL tear or injury treatment

Your doctor may recommend nonsurgical ACL tear or injury treatments, including:

Swelling reduction

To reduce swelling in the first few days after an ACL injury, your doctor may recommend:

• Applying ice for 10 to 20 minutes at a time, several times a day.
• Compressing your knee by wrapping it tightly with a bandage. Your health care provider will teach you how to wrap your knee.
• Elevating your knee above your heart by lying down and resting your leg on pillows.
• Taking anti-inflammatory medications such as ibuprofen. Your health care provider will inform you if over-the-counter anti-inflammatory medications are safe.

Activity restrictions after ACL injury

Your doctor will advise you on how long to rest each day and what knee movements to avoid. Crutches can help relieve pressure on your knee and support healing during the initial recovery period.

You'll need to avoid sports, like jogging and swimming, for several months. You'll also need to refrain from other activities that stress your knee. Follow-up MRIs or other imaging tests will show whether your ACL has healed enough for you to resume certain activities.

Physical therapy and rehabilitation

Most people can start physical therapy when their swelling and pain improve.

Your UPMC physical therapist will design a complete ACL rehabilitation program based on your:

• ACL injury and type of treatment.
• Desired level of activity.
• Fitness level.
• Sports background.

The goals of physical therapy and rehabilitation are to:

• Improve strength and stability in the muscles around your knee.
• Reduce swelling in your knee.
• Restore — as close as possible — the normal range of motion in your knee.
• Reduce your risk of reinjury — especially if you plan to return to sports.

Your physical therapist will help you slowly work up to 30 or more repetitions of each suggested exercise. If you are an athlete, your physical therapist will incorporate sport-specific exercises into your rehabilitation plan.

Some of the exercises ACL rehabilitation includes are:

• Calf raises — Standing upright and holding on to a chair, slowly raise your heels so you are standing on the balls of your feet. Hold this for a few seconds, and then lower your heels back down.
• Band exercises — Your physical therapist can teach you how to use exercise bands to strengthen the muscles on the inner and outer sides of your legs.
• Knee bends — Sitting on the floor with your legs straight out in front of you, put your hands behind the thigh of your injured leg. Then, pull the knee to your chest with your back straight before slowly lowering your leg.
• Quad exercises — When sitting with your leg straight, flex your quadriceps muscles (the muscles at the front of your thigh) and hold for 10 seconds.
• Straight leg raises — Lie down with your uninjured knee bent, your foot on the floor, and your injured leg straight. Flex your quad muscles and lift your straight leg a foot or so off the floor, and then slowly lower it.

Immobilization

Your doctor may recommend a brace that keeps your knee straight for several weeks. After a few weeks, you can gradually increase movement with the help of a physical therapist.

Braces

Some people prefer to wear flexible knee braces after an ACL injury. Although they may provide extra support, research hasn't shown that they improve ACL injury healing or prevent future ACL injuries.

Why Would I Need Nonsurgical ACL Tear or Injury Treatment?

Nonsurgical ACL tear or injury treatment may be best for people with minor ACL injuries, older adults, and people at a higher risk of complications related to surgery.

Who is a candidate for nonsurgical ACL therapy?

You may benefit from nonsurgical treatment for an ACL injury if you:

• Are older than 50. Older people have a higher risk of complications with ACL surgery. However, surgery can still be the best option for older people, especially if they don't have other health problems.
• Don't play sports, especially sports that require pivoting or twisting your knee.
• Have a minor ACL injury, such as an ACL that's overstretched rather than torn.
• Have health problems, such as diabetes or bleeding disorders, that increase your risk of surgical complications.
• Smoke. People who smoke don't heal as well post-surgery as people who don't smoke.

Alternatives to nonsurgical ACL therapy

• Surgical ACL treatment.

What Are the Risks and Complications of Nonsurgical ACL Care?

Nonsurgical treatment means you avoid the potential complications of surgery, such as infection, bleeding, and nerve damage.

But not having surgery also has risks, including:

• Arthritis, or pain and stiffness in your knee joint due to long-term inflammation.
• A worsened injury — A partially torn ACL can tear completely, so following activity restrictions and physical therapy guidelines is important.
• Inflammation that damages other parts of your knee, such as your cartilage or your meniscus.
• Knee instability with forward/backward movements and rotational movements.

Your doctor can explain the benefits and risks of a nonsurgical approach versus surgery for your specific situation.

Your doctor may advise you to try a nonsurgical approach first and monitor your progress. Your doctor will assess your symptoms through follow-up appointments and repeat imaging tests as needed. If nonsurgical treatments aren't working, your doctor may suggest surgery.

What Should I Expect From Nonsurgical Therapy for an ACL Injury?

ACL injuries can take anywhere from weeks to months to heal. The timeline will depend on the severity of your injury, your age, and your general health. It also depends on how well you stick to your activity restriction guidelines and physical therapy exercises.

You should let your doctor know right away if you notice pain, swelling, or "popping" of your knee. These may be signs that your ACL isn't healing well.

What’s the prognosis after nonsurgical ACL injury treatment?

Nonsurgical ACL injury care can help you return to your everyday activities. Your prognosis will depend on the extent of your injury, as well as your activity level, age, and overall health. Your doctor will discuss your expected prognosis with you.

What’s the success rate of nonsurgical ACL injury treatment?

Nonsurgical ACL care is highly successful for people with minor injuries, as well as those who are not candidates for surgery. However, some ACL injuries or tears may require ACL surgery.

If you need ACL surgery, the experts at UPMC have decades of experience in ACL injury repair. Our multidisciplinary team will take a personalized approach to your care, helping to deliver the best possible results.

Why Choose UPMC for Nonsurgical ACL Care?

When you choose UPMC for nonsurgical ACL care, you will receive:

• Access to world-class orthopaedic expertise — Our world-renowned experts treat the full spectrum of knee disorders using the latest surgical and nonsurgical techniques.
• Advanced diagnostic care — We’ll work with you to understand the extent of your injury and develop a comprehensive treatment plan.
• A full range of treatment options — We offer nonsurgical care, as well as robotic and traditional surgical approaches, depending on your individual care needs.

By UPMC Editorial Staff. Last reviewed on 2025-03-07.