Rehabilitation and assessment practices following anterior cruciate ligament injury: A survey of Australian physiotherapists

Objective: This study aimed to investigate the current beliefs and practices among Australian physiotherapists regarding the management of anterior cruciate ligament (ACL) injuries.

Design: Cross-sectional survey.

Setting: Online survey.

Participants: Australian physiotherapists.

Outcome measures: The survey assessed beliefs and practices regarding non-operative management, ACL reconstruction, pre- and post-operative rehabilitation, and return to sport (RTS) criteria. Frequencies and percentages summarized survey responses, and chi-square or Fisher's exact tests assessed whether beliefs and practices were influenced by experience (≤6 years or >6 years) and annual caseload (<6 or ≥6 patients).

Results: In total, 419 physiotherapists were included, with 367 completing the survey in its entirety. Most physiotherapists (86.8%) consider non-surgical management alternatives for patients. Two-thirds (59.8%) recommend a minimum of 9-12 months before RTS, emphasizing recovery of knee strength (93.9%) and psychological readiness (93.9%). Of those who assessed strength, 32.5% use manual muscle testing, and 37.4% assess strength from hop testing. The 63.5% of respondents who reported barriers to implementing best practice ACL management, cited lack of resources (69.1%) and patient non-compliance (67.8%) as the most common reasons.

Conclusion: This survey of Australian physiotherapists showed alignment with evidence-based ACL guidelines but highlighted differences from international practices and variations by experience and caseload.