ACL Surgery Recovery Guide

Rehabilitation After ACL Repair or Reconstruction

General Principles:

It is impossible to develop a "cookbook" method for how to rehabilitate a patient after ACL repair or reconstruction. The ACL surgery recovery protocol should be patient-specific with progress based on the patient achieving specific criteria as well as consideration of the normal biology for ACL graft healing.

ACL rehabilitation consists of distinct phases. It is possible to overlap phases depending on the individual progress of the patient. It is also possible to move backward if a patient struggles with a particular phase of the ACL rehab protocol. We have provided approximate acl recovery times for each phase, but actual ACL recovery times vary among individuals.

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ACL Surgery Recovery Phase I: Pre-Operative

With this ACL rehab protocol, patients presenting with an ACL deficient knee may be seen in physical therapy, with an athletic trainer prior to ACL surgery.

  • Restore full extension and >90 degrees of flexion and ability to perform straight leg raises (SLRs) and control swelling
  • Ensure complete understanding of the basic principles of rehabilitation including:
    • Full terminal knee extension
    • Early weight bearing - if there isn't a meniscus tear otherwise non-weight bearing
    • Closed chain strengthening

ACL Surgery Recovery Phase IIA:
Control Pain and Swelling

With this ACL rehab protocol, patients presenting with an ACL deficient knee may be seen in physical therapy, with an athletic trainer prior to ACL surgery.

  • Full passive knee extension and 110 degrees of flexion (90 degrees if meniscus repaired)
  • Independent straight leg raise- electrical stimulation at 60 degrees knee flexion
  • Weight bearing as tolerated unless meniscus repair, then surgeon may order non-weight bearing for 2 weeks
  • Reduce swelling- cryotherapy and e-stim

ACL Surgery Recovery Phase IIB:
Early Mobilization

Approximately Weeks 2-6

  • Minimal swelling and soft tissue healing - continue cryotherapy
  • Unlock brace for normal gait when able to perform SLRs without a lag
  • Maintain full extension with heel props and prone hangs
  • Flexion >120 degrees
  • Strengthen core

ACL Surgery Recovery Phase III: Static Conditioning

Usually by 6-12 Weeks After ACL Surgery but must be based on attaining all goals for Phase II

  • Full flexion to 135 degrees
  • Consistent weight room and moderate speed strengthening
  • Early return to agility and sport specific drills - Static drills

ACL Surgery Recovery Phase IV: Dynamic

3-6 months after ACL surgery

Progress if no regression, swelling, giving-way, increased pain or stiffness (soreness is normal)

  • Quadriceps tone continues to improve with noticeable quadriceps definition returning
  • Return to full daily activities
  • At least 80% strength
  • Proprioceptive/agility specific program
  • Complete a sport specific functional progression

ACL Surgery Recovery Phase V: Ballistic

3-6 months after ACL surgery

Progress if no regression, swelling, giving-way, increased pain or stiffness (soreness is normal)

  • More advanced sports-specific drill at competitive speeds
  • Controlled participation in practices

Graduation from Phase V of the ACL rehab protocol means the patient is ready to progress to practice time and supervised competition. Close observation by athletic trainer and coaches is needed to identify any red flags signifying lack of confidence, apprehension or favoring. If red flags present then may need to move back to Phase IV.