Phase four to six

Phase Four: Strength Phase


At six weeks the graft should be solidly fixed into bone so that more vigorous strength training can start. Thigh muscle tone and definition (quadriceps / hamstrings) will hopefully have been maintained during the first post op phase and now the main strength work can begin.  


Progress is monitored and controlled by the recovery of strength and muscle control.  It is important to avoid too rapid progress, as there is a risk of developing overload complications. 


Review Goals:
Full range of movement 

No swelling

Confident feeling of stability

Phase Five: Early Sport Training Phase


Pivoting and cutting movements are introduced at this stage, building up to light sport training. This involves a progressive programme of slow and moderate speed strength training and agility drills. Manual work should be possible within the restraints of the occupation. Exercises for power and agility training are introduced.  


Many sport specific skill training exercises can be introduced at this stage and detail for particular sports is given in the next section as there is some overlap during these phases. The new ligament is still at significant risk of re-injury or of stretching out if progress back to full levels of sport is too fast.

There is no one solution that fits all individuals and great emphasis is given on the care in progressing through this phase back to sport.  Supervision by a Physio, sports coach or trainer is key, as drill and skill acquisition is dependent on individual muscular control patterning in addition to individual relative strength deficits around the hip, knee and ankle.


Review Goals:
Full Range of movement

Functional and Strength tests: 85% of normal side

Return to non contact sports training

Phase Six: Return To Sport Phase



The aim of this phase is to progress sport training and to develop strength and endurance levels to allow return to full sporting activity. This takes time, especially in building up confidence to progress to full contact activities.


Return to contact sport is not recommended until strength and functional outcomes are measured at greater than 85% of the normal knee.   It should be remembered that the time to regain pre-injury level of skill and performance is very variable but can take 3 – 4 months of training and playing.  This confidence can be helped by introducing modified training and specific drills early, often in conjunction with club or team activities.


Progress is best achieved in conjunction with a general fitness programme, as this will have reduced over time since the injury and surgery.   Full contact sport is, in general, best avoided until able to tolerate a full ­training session with confidence in full fitness and endurance.

Full details of return to sport rehabilitation should be obtained from the surgical and rehabilitation team. 

Latest Statistics

The NLR has been successfully gathering patient data since 2013, after it was launched at BASK.


There are currently:


Number of active users: 712


Number of Pathways: 12098


Total Number of Registered Patients: 11796

(includes patients awaiting surgery)

Print Print | Sitemap
© National Ligament Registry powered by Amplitude Clinical Outcomes
Website managed by SoBold
Privacy Policy