Can You Walk on a ACL Tear? (Physio’Tips)

You have a rupture of the cruciate ligaments (anterior, posterior or both) of the knee, you wonder if you can walk despite this injury?

How ? With crutches, a splint ? How long ? How do you know if you can let go of the splint and crutches?

Whether or not you have had surgery for this cruciate ligament tear, I will give you information on resuming walking after this injury.

For this I rely on my experience as a physiotherapist and on the results of international scientific publications (all references at the end of the article).

Quick answer : yes, you can still walk immediately after a cruciate ligament injury, whether operated or not. You will simply have to adapt your walking to relieve pain and limit knee instability.

I suggest you develop this in more detail in this article!

In this article, I mainly talk about rupture (or tear) of the anterior cruciate ligaments, because they are the most common. The same reasoning can apply for ruptures/tears of the posterior cruciate ligaments of the knee.

Last updated: October 2023.
Declaration of financial interests: no affiliate links. My complete declaration of links of interest is in legal notices.

Why do we have trouble walking after a torn anterior cruciate ligament?

The anterior cruciate ligaments (ACL) are two structures that intersect in the center of the knee.

One of their main roles is to stabilize the knee : to prevent the knee from twisting when moving, especially when jumping or twisting.

But these are not the only structures that ensure knee stability.

When these cruciate ligaments are torn , the knee loses (a little) its stability and this can lead to difficulty walking.

But difficulty walking can also come from other things after an anterior cruciate ligament injury:

• To repair damaged tissues (ligaments), your body responds by causing inflammation . Your knee may become swollen, red, and hot . This can limit walking, although it does not make walking dangerous;
• the ligaments also allow us to feel the position and movement of the knee. This is called proprioception. You may also have difficulty walking because you are less aware of the position of your knee in space.

Walking can be hampered after a rupture of the anterior cruciate ligaments due to reduced knee stability, inflammation and reduced proprioception . Hence the need often to adapt walking .

Should you still use crutches to walk after a cruciate ligament rupture?

When you have difficulty walking “normally”, you can use technical walking aids . Most often crutches, sometimes a walker or walking sticks.

Why can these technical aids make walking easier ?

• Because you can relieve knee pain by putting a little less pressure on it (and a little more on the canes)
• Because we can stabilize the knee by limiting the weight we put on it (always pressing on the crutches)
• Because we can feel safer when walking, more secure

These feelings vary depending on the person.

And surgeons, doctors and physiotherapists sometimes recommend different things to their patients. Some “forbid” walking without a crutch . Others encourage walking without a crutch .

There is little data from studies specifically on this subject: it is complicated to isolate the parameter “walking with or without crutches” from other things that can influence recovery.

It is reasonable to believe that in the long term, whether or not you walk with crutches does not influence the quality or speed of your recovery after a cruciate ligament rupture.

How long should you stay on crutches with a torn ACL?

As a physiotherapist, I have seen all the scenarios in the days following a rupture of the anterior cruciate ligaments of the knee :

• some people do not need crutches and walk as if nothing had happened;
• others will only need crutches for a few days, and only to leave the house;
• others will need crutches for several weeks.

There is therefore no minimum or maximum duration for using crutches after a rupture of the anterior cruciate ligaments .

It’s up to you to adapt depending on how you feel . If necessary, seek the advice of your physiotherapist or other health professional if you need an outside eye!

Should we put a knee brace with a torn ACL?

In the short term, there are advantages and disadvantages to wearing a splint (compared to not wearing one) after a cruciate ligament rupture.

✅ Benefits of the short-term splint:

• relieves pain;
• facilitates walking with a feeling of stability.

❌ Disadvantages of short-term splint:

• limits recovery of knee flexion;
• restrictive to remove, put back (for washing and at night, or because it slips throughout the day).

This is why you will find so many physiotherapists and surgeons who insist that you wear one . Just like others who encourage you not to wear one!

I know that as a patient, it is sometimes complicated to be confronted with these contradictory opinions .

My experience is as follows: in the vast majority of cases, as a patient, we are entirely capable of “feeling” the approach that suits us best .

It’s up to you to see if you are really more comfortable with the splint in the first days (or even weeks). Or if, on the contrary, you prefer to do without it . There is no absolute right way to do this.

In the long term, everything suggests that people with an anterior cruciate ligament injury of the knee recover on average in the same way , whether or not they had a brace .

You will sometimes hear about a knee orthosis: it is the same thing as a knee brace. We also talk about knee braces: in general, knee braces are smaller and less rigid, and stabilize the knee less than an orthosis/splint.

How long to keep the splint after a cruciate ligament rupture?

This is the same reasoning as knowing how long to keep on crutches after a torn cruciate ligament .

There is no minimum or maximum duration , it will depend on how you feel, your apprehension, how much relief you have or not with the splint.

• Some people never wear a splint after a cruciate ligament injury.
• Others only keep the splint on for 2/3 days.
• Others keep the splint on for several weeks.

It’s up to you to find the right compromise for you for the duration of wearing the splint! And discuss it with your physiotherapist if you need an outside eye!

Should we use a knee brace in the event of a cruciate ligament problem?

The same reasoning is valid for a knee brace as for a splint.

A knee brace is smaller and less rigid than a splint.

It will therefore stabilize the knee even less, but therefore less promote stiffness.

We have no reason to think that putting on a knee brace is better (or worse) than putting on a splint or not using anything after a cruciate ligament tear .

How do you know when you can walk longer?

After an injury to the cruciate ligaments, you start walking again straight away . You simply need to adapt your dosage , depending on the discomfort you experience.

There is no maximum walking distance or duration to follow in the days or weeks following a rupture of the anterior cruciate ligaments.

Some people have a very limited walking distance: a few tens or hundreds of meters. Others have no difficulty walking for more than 30 minutes at a good pace.

How do you know what the right dosage is for you ? Here are some ideas:

• If you have some bearable pain when walking (or after walking), it’s not something to worry about. as long as they remain tolerable, walking remains recommended;
• Gradually increase one setting at a time . For example, either the duration of walking, or the fact of doing without crutches, or the fact of walking faster, or walking on an incline. By increasing only one parameter at a time, you will be better able to identify which one may be causing the problem;
• If you overdo it one day and your knee swells more and becomes hot and more painful , especially at night, don’t panic. Your knee will return to its normal state in a few days. Simply slow down the pace and re-increase your activities more gradually;
• If you can’t figure this out on your own, physiotherapists are the healthcare professionals most used to supervising the rehabilitation of people with cruciate ligament injuries . You can ask for their opinion to guide you.

Resumption of walking after ACL surgery: what are the particularities?

So far, I’ve mostly talked about people who haven’t had ACL reconstruction surgery.

The same reasoning remains valid after cruciate ligament surgery . Except that in general, after surgery, you will have more precise recommendations given by your surgeon.

Some recommend following a very strict protocol , with minimum periods of wearing a splint and crutches (and prohibited movements to limit rupture of the new cruciate ligament). It’s up to you to discuss it with them or your physiotherapist if you find this protocol unsuitable for your situation 🙂.

And this regardless of the operation you had : KJ, DIDT, DT3, DT4, SAMBBA, Lemaire, TFL (ternodesis of the fascia lata), MacIntosh, Gracilis, tenodesis or reconstruction of the ALL.

Crutches after ACL surgery?

It is reasonable to believe that crutches allow you to return to walking more quickly after anterior cruciate ligament surgery.

But whether walking for a long time with it or doing without it altogether has no significant long-term impact on recovery.

However , it is rare to be able to completely do without crutches in the days following anterior cruciate ligament surgery (or else you limp a lot).

Source: Kachanathu 2011

Splint after ACL surgery?

Wearing a splint after ACL surgery depends on your preferences and those of the medical and paramedical team supervising you.

Some surgeons and physiotherapists:

• never recommend splint,
• others still recommend a splint;
• others adapt according to the specific apprehensions and difficulties encountered by patients.

This topic is still the subject of debate in academic sports medicine publications.

To date, no long-term benefit from wearing a brace (or not using a brace) has been seen with respect to knee laxity, range of motion, or function after surgery. of the ACL.

This does not limit the risk of complications, nor does it make it worse.

Source: Bordes 2017; Yapici 2022

Conclusion: If you feel more comfortable with a splint, you can wear one for a few days or even a few weeks. But doing without it completely after a rupture of the operated anterior cruciate ligament is possible .

Questions, comments? See you in the comments ! I wish you a good recovery 🙂!

See also :

• Rehab Protocol for ACL tear without surgery