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MK Orthopädie Währing
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Long-term Consequences & Sports
knowledge
29. September 2025

Long-term con­se­quen­ces af­ter ACL tear & Sports af­ter ACL tear

An ACL tear (usually of the an­te­rior cru­ciate li­ga­ment) is a com­mon knee in­jury – for ex­am­ple, in sports in­vol­ving ab­rupt ch­an­ges in di­rec­tion, stops, or jumps. Even af­ter suc­cessful tre­at­ment – whe­ther sur­gi­cal or con­ser­va­tive – the knee can re­main af­fec­ted in the long term. It is the­r­e­fore all the more im­portant to re­co­gnize pos­si­ble long-term con­se­quen­ces early and to pre­vent them specifically. 

What hap­pens in an ACL tear?

The an­te­rior cru­ciate li­ga­ment sta­bi­li­zes the knee du­ring for­ward mo­ve­ments and ro­ta­ti­ons of the lower leg. If it te­ars – com­ple­tely or par­ti­ally – the knee lo­ses sta­bi­lity. Other struc­tures such as the me­nis­cus, car­ti­lage, or col­la­te­ral li­ga­ments can the­r­e­fore be sub­jec­ted to in­creased stress. This in­crea­ses the risk of se­con­dary damage. 

Pos­si­ble long-term con­se­quen­ces af­ter ACL tear

Af­ter an ACL tear, the fol­lo­wing con­se­quen­ces can oc­cur – de­pen­ding on tre­at­ment, re­ha­bi­li­ta­tion, and in­di­vi­dual factors:



Responsive Table

Long-term con­se­quence What hap­pens
Knee in­sta­bi­lity The knee can “give way” un­der stress, espe­ci­ally du­ring ro­ta­tio­nal mo­ve­ments or on un­even ground. Per­sis­tent in­sta­bi­lity stres­ses the me­ni­sci, car­ti­lage, and col­la­te­ral ligaments.
Se­con­dary me­nis­cal damage Due to in­sta­bi­lity, a me­nis­cus of­ten te­ars sub­se­quently, or exis­ting me­nis­cal da­mage worsens.
Car­ti­lage wear and osteoarthritis Over­loa­ded joint sur­faces, im­pro­per loa­ding, and con­ti­nuous mi­cro-da­mage lead to long-term car­ti­lage da­mage – with the risk of knee osteoarthritis.
Rest­ric­ted range of motion Rest­ric­tions in knee fle­xion or ex­ten­sion due to scar tis­sue, joint ch­an­ges, or in­suf­fi­ci­ent mo­ve­ment af­ter in­jury or surgery.
Chro­nic pain Pain du­ring exer­tion, in an unsta­ble knee, or due to exis­ting se­con­dary da­mage to the me­nis­cus and car­ti­lage. Also cau­sed by joint ef­fu­si­ons or in­flamm­a­tory processes.
Al­te­red mus­cle strength and coordination Mus­cles (e.g., an­te­rior and pos­te­rior thigh mus­cles) can be wea­k­ened or work asym­me­tri­cally; pro­prio­cep­tion (per­cep­tion of joint po­si­tion) can be impaired.
When is sur­gery ne­ces­sary for an ACL tear?

Not every tear ne­ces­s­a­rily re­qui­res sur­gery. Sur­gery is par­ti­cu­larly ad­vi­sa­ble if: 

  • the knee is unsta­ble (e.g., gi­ves way du­ring daily ac­ti­vi­ties or sports)
  • there is high ath­le­tic de­mand (foot­ball, ten­nis, ski­ing, etc.)
  • ad­di­tio­nal in­ju­ries (me­nis­cus, car­ti­lage) are present
  • there is an in­creased risk of long-term con­se­quen­ces (e.g., in young, ac­tive patients)

The aim of the sur­gery is to res­tore knee joint sta­bi­lity and pre­vent long-term damage.

What helps to avoid or mi­ti­gate long-term con­se­quen­ces af­ter an ACL tear?

A struc­tu­red tre­at­ment and re­ha­bi­li­ta­tion plan is cru­cial. The fol­lo­wing me­a­su­res help: 

  1. Prompt assessment

Im­me­dia­tely af­ter the ACL in­jury (LINK https://www.mk-orthopaedie.at/schmerzbereich/kreuzband/ ), a tho­rough dia­gno­sis should be made and the ap­pro­priate form of the­rapy (con­ser­va­tive or sur­gi­cal) selected.

  1. High-qua­lity sur­gi­cal technique

If sur­gery is per­for­med, an ana­to­mic­ally pre­cise ACL re­con­s­truc­tion with sta­ble fix­a­tion is im­portant – ide­ally mi­ni­mally in­va­sive by an ex­pe­ri­en­ced surgeon.

  1. Tar­ge­ted rehabilitation
  • Mus­cle streng­thening (espe­ci­ally quad­ri­ceps and hamstrings)
  • Mo­bi­lity enhance­ment (fle­xion & extension)
  • Ba­lance and coor­di­na­tion training
  • pro­prio­cep­tive trai­ning for bet­ter con­trol and safety
  1. Long-term fol­low-up care

Even af­ter re­ha­bi­li­ta­tion, re­gu­lar check-ups and a tar­ge­ted in­crease in load are cru­cial to keep the knee per­ma­nently stable.

Sui­ta­ble Sports Af­ter ACL Tear & Sports to Ap­proach with Caution

Fol­lo­wing con­sul­ta­tion with Priv.-Doz. DDr Ma­xi­mi­lian Kas­pa­rek, MSc, the fol­lo­wing ac­ti­vi­ties are recommended:

Sui­ta­ble Sports

  • Swim­ming (espe­ci­ally back­stroke or crawl)
  • Cy­cling (sta­tio­nary or out­doors, with mo­de­rate intensity)
  • Nor­dic Walking
  • Gym­nastics, Pi­la­tes, Yoga (ad­apted, joint-friendly)
  • Aqua­jog­ging

These exer­ci­ses streng­then mus­cles, coor­di­na­tion, and con­fi­dence in one’s own knee – a cen­tral buil­ding block of any suc­cessful ACL rehabilitation.

Sports to Ap­proach with Caution

  • Soc­cer, Bas­ket­ball, Handball
  • Ten­nis, Skiing
  • Jum­ping or twis­ting ac­ti­vi­ties, e.g., court sports
  • Jog­ging on hard sur­faces wi­t­hout a prior sta­bi­lity phase
Af­ter an ACL tear, your ath­le­tic fu­ture is de­ter­mi­ned not by chance, but by the cor­rect therapy.
Re­gu­lar Check-ups – A Reminder

The knee should be re­gu­larly che­cked – even months af­ter sur­gery or con­ser­va­tive therapy:

  • First check-up af­ter ap­prox. 6 weeks
  • Fol­low-up ap­point­ments at in­ter­vals of 3–6 months in the first year
  • The­re­af­ter: once an­nu­ally for fol­low-up mo­ni­to­ring – espe­ci­ally with ath­le­tic activity

This in­vol­ves as­ses­sing sta­bi­lity, mo­bi­lity, mus­cle ba­lance, and, if ne­ces­sary, ima­ging findings.

Con­clu­sion: Long-term con­se­quen­ces af­ter an ACL tear are avoidable

An ACL tear does not have to lead to per­ma­nent pro­blems – if ac­tion is ta­ken early and tre­at­ment is in­di­vi­du­ally ad­apted. Key fac­tors are: 

  • ac­cu­rate dia­gno­sis and consultation

  • sta­ble sur­gi­cal tech­ni­que (if necessary)

  • con­sis­tent rehabilitation

  • re­gu­lar fol­low-up care

  • mindful re­turn to sports and daily life

With a ho­li­stic ap­proach, the risk of long-term con­se­quen­ces af­ter an ACL tear can be si­gni­fi­cantly re­du­ced – for an ac­tive, pain-free life.

Have you sus­tained an ACL tear and want to know how you can con­ti­nue with sports?

For in­di­vi­dual con­sul­ta­tion and tre­at­ment, I am available at my pri­vate prac­tice in Vi­en­na’s 18th dis­trict. Sche­dule an ap­point­ment to cla­rify your ques­ti­ons and dis­cuss the best pos­si­ble therapy.

SCHE­DULE AN AP­POINT­MENT

10 Com­mon Ques­ti­ons about ACL and Sports

1. Can I con­ti­nue to play sports with an ACL tear?

In the acute phase im­me­dia­tely fol­lo­wing the tear, sports are not re­com­men­ded. For a com­plete tear, a de­cis­ion re­gar­ding sur­gery or con­ser­va­tive tre­at­ment should be made ba­sed on the de­gree of in­sta­bi­lity. Sub­se­quently, joint-fri­endly sports with a sta­ble knee are pos­si­ble – un­der me­di­cal guidance. 

2. Which sports are re­com­men­ded af­ter an ACL tear?

Cy­cling, swim­ming (back­stroke or crawl), Nor­dic wal­king, and sta­bi­li­zing strength exer­ci­ses are well-sui­ted. It is im­portant to gra­du­ally in­crease the load and con­trol movements. 

3. When can I re­sume sports af­ter ACL sur­gery?

De­pen­ding on re­co­very pro­gress: light ac­ti­vity (e.g., cy­cling) af­ter ap­pro­xi­m­ately 6 weeks, jog­ging af­ter ap­pro­xi­m­ately 3–4 months, and cont­act sports (e.g., soc­cer, ten­nis) no ear­lier than 6–9 months – al­ways con­tin­gent on strength, sta­bi­lity, and me­di­cal clearance.

4. Is sur­gery ne­ces­sary af­ter an ACL tear to re­turn to sports?

Not ne­ces­s­a­rily. For in­di­vi­du­als with a low ac­ti­vity le­vel and sta­ble knee mus­cu­la­ture, con­ser­va­tive tre­at­ment is also an op­tion. Ho­we­ver, for phy­si­cally ac­tive in­di­vi­du­als who wish to per­form ch­an­ges of di­rec­tion or jumps, sur­gery is usually advisable. 

5. What hap­pens if I re­turn to sports too early?

Re­tur­ning to sports too early can exa­cer­bate in­sta­bi­lity, de­lay he­al­ing, or lead to se­con­dary da­mage such as me­nis­cal te­ars and car­ti­lage da­mage. Sports should only be re­su­med when the joint is sta­ble and pain-free. 

6. Can I re­turn to my pre­vious sports le­vel?

In many ca­ses, yes – with ef­fec­tive the­rapy, tar­ge­ted re­ha­bi­li­ta­tion, and pa­ti­ence. Ho­we­ver, re­tur­ning to a com­pe­ti­tive le­vel can take 9–12 months. It is cru­cial that no in­sta­bi­lity or com­pen­sa­tory mo­ve­ments persist. 

7. Which exer­ci­ses are par­ti­cu­larly ef­fec­tive in streng­thening my knee af­ter an ACL tear?

A tar­ge­ted trai­ning pro­gram helps to res­tore the sta­bi­lity and re­si­li­ence of the knee af­ter an ACL tear. Im­portant: All exer­ci­ses should only be per­for­med af­ter con­sul­ting with your trea­ting phy­si­cian or physiotherapist.

Re­com­men­ded exercises:

  • Su­pine leg rai­ses to ac­ti­vate the quadriceps
  • Mini-squats (up to ap­prox. 45°) against a wall or freestanding
  • Step-ups onto a low step, con­trol­led as­cent and descent
  • Sin­gle-leg stance on a sta­ble or unsta­ble sur­face for ba­lance training
  • Lun­ges (only with good con­trol and stability)

The goal is to streng­then the mus­cu­la­ture, im­prove coor­di­na­tion, and gra­du­ally re-ac­cus­tom the knee to mo­ve­ment and load – wi­t­hout pain or ove­r­use.

8. How do I know if my knee is re­ady for sports?

A sense of sta­bi­lity, free­dom from pain, sym­me­tri­cal mus­cle strength, and suc­cessful com­ple­tion of func­tional tests (e.g., Y‑Balance Test) are cru­cial. A sports or­tho­pe­dic ex­ami­na­tion be­fore re­tur­ning to ac­ti­vity is recommended. 

9. What are the risks of play­ing sports wi­t­hout an ACL?

Wi­t­hout a sta­ble ACL, there is a long-term risk of me­nis­cal da­mage, car­ti­lage wear, and pre­ma­ture os­teo­ar­thri­tis. The risk is si­gni­fi­cantly ele­va­ted, espe­ci­ally in stop-and-go sports. 

10. How can I pre­vent a re­cur­rent ACL tear?

Th­rough tar­ge­ted coor­di­na­tion and sta­bi­lity trai­ning, cor­rect tech­ni­que (e.g., when landing af­ter a jump), ef­fec­tive mus­cle de­ve­lo­p­ment, and con­trol­led load progression.

If you found this ar­ticle hel­pful, you might also be in­te­res­ted in other posts from our blog.

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Priv.Doz. DDr.
Maximilian Kasparek, MSc
haelsi Gesundheitszentrum im Achtzehnten Theresiengasse 46/2 1180 Vienna

+43 1 399 08 63
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