ACL Rehabilitation: Evidence-Based Update

Course overview

Anterior cruciate ligament (ACL) injuries remain among the most consequential musculoskeletal injuries encountered across sports medicine, orthopedic surgery, physical therapy, and nursing practice. With an estimated 200,000 ACL injuries occurring annually in the United States alone, and a rising incidence among adolescent athletes, the clinical and socioeconomic burden of these injuries demands that allied health professionals maintain current, evidence-based knowledge to optimize patient outcomes across the entire continuum of care. The landscape of ACL injury management has evolved substantially over the past five years. Advances in surgical technique, including the emergence of quadriceps tendon autograft and lateral extra-articular tenodesis, have expanded the options available for reconstruction. Simultaneously, the rehabilitation paradigm has shifted decisively from time-based protocols to criterion-based progression models that integrate objective functional milestones, limb symmetry indices, and psychological readiness assessments into return-to-sport decision-making. Multimodal, opioid-sparing pain management strategies have become the standard of care, reflecting broader healthcare efforts to reduce opioid dependence while maintaining effective analgesia. Digital health technologies, including telerehabilitation platforms and wearable sensors, are increasingly being integrated into postoperative care pathways. This continuing education course provides a comprehensive, evidence-based review of ACL rehabilitation for physical therapists, occupational therapists, nurses, and allied health professionals. Drawing from the most current clinical practice guidelines, systematic reviews, and consensus statements published between 2022 and 2026, the course covers ACL anatomy and injury mechanisms, clinical evaluation and imaging, surgical decision-making and graft selection, prehabilitation, phased postoperative rehabilitation, multimodal pain management, the nursing role across care settings, multidisciplinary care coordination, adolescent-specific considerations, return-to-sport testing and clearance, and long-term outcomes. Emphasis is placed on criterion-based rehabilitation milestones, psychological readiness assessment, opioid stewardship, and the integration of emerging technologies. Upon completion, learners will be equipped to apply current evidence to optimize patient outcomes across the continuum of ACL injury management, from initial injury through long-term follow-up. The course is organized into eight modules, each addressing a critical dimension of ACL injury management. Module 1 establishes the foundational knowledge of ACL anatomy, biomechanics, and injury mechanisms, including the compelling evidence for neuromuscular training prevention programs. Module 2 addresses clinical evaluation, imaging, and diagnosis, with emphasis on differentiating partial from complete tears and recognizing concomitant injuries. Module 3 examines the complex landscape of surgical decision-making and graft selection. Module 4 covers prehabilitation and early postoperative rehabilitation, establishing the criterion-based milestones that guide the entire recovery process. Module 5 extends through intermediate and advanced rehabilitation to return-to-sport clearance. Module 6 addresses pain management, the nursing role, and multidisciplinary care coordination. Module 7 synthesizes adolescent-specific considerations, return-to-sport testing frameworks, complications, and long-term outcomes. Module 8 integrates the preceding content through four detailed case studies spanning the spectrum of clinical presentations encountered in practice.