After ACL reconstruction surgery patients want to know how soon they can get back to normal activities and what to expect throughout the rehabilitation process. Every patient heals differently, so there is no one size fits all method for rehab after ACL repair or reconstruction.  However, Dr. Goradia can provide general protocols and guidelines to familiarize you with the process.

ACL Rehabilitation Phases

After surgery, ACL rehabilitation consists of three distinct phases that can overlap depending on the individual progress of the patient.  If healing is delayed or a patient is struggling with a particular phase it is possible to move backward to the previous phase.

Phase IIA: Control Pain & Swelling

Phase IIA begins immediately after surgery and, for most patients, goes through day 14.

The First Week After ACL Surgery:

Immediately after ACL preservation surgery ice is placed on the patient’s knee. This provides compression and cold to minimize pain and swelling. During the first week, patients should stay lying down with the leg elevated as much as possible. Ice and elevation are important to reduce swelling and pain and lead to increased range of motion.  Ice should remain on the knee at all times, except when performing motion exercises.

When getting up to go to use the bathroom, the patient is encouraged to put weight on the knee, as much as they can tolerate while using their crutches, walker and knee immobilizer.

During this phase goals for the patient are:

  1. Full passive knee extension and 110 degrees of flexion (or 90 degrees if the meniscus repaired)
  2. Independent straight leg raise- electrical stimulation at 60 degrees knee flexion
  3. Weight bearing as tolerated unless there was a meniscus repair, then non-weight bearing for 2 weeks
  4. Reduce swelling

Around day 3, patients will begin physical therapy.  Many exercises at this phase include:

  1. Ankle pumps starting day of surgery to prevent deep vein thrombosis (DVT)
  2. Knee extensions done on the hour
  3. Knee flexion
  4. Heel slides with towel and wall slides when able
  5. Leg control exercises including active quadriceps contraction with quad sets and straight leg raises

Phase IIB: Early Mobilization

This phase typically takes place between 2-6 weeks after ACL reconstruction surgery. At this point after surgery patients are still using ice (cryotherapy) to keep swelling minimized and promote soft tissue healing.  If the meniscus was repaired, patients should be able to put their full weight on while using their brace during this stage.  Other patients can unlock the brace for normal walking without assist devices and demonstrate ability to lock the knee with weight shifted to ACL leg.
Tests to gauge your progress during this stage include measuring prone heel height difference, supine knee flexion compared to contralateral knee and thigh circumference 10 & 15cm above patella.

Exercises In Phase IIB:

  • Exercises during this phase will focus on maintaining full range of motion and patients are encouraged to lock the knee by shifting their weight to the ACL leg so the extension is full and knee if fully locked.
  • Wall slides and heel slides are common exercises and stationary bike workouts are used to increase flexion.  Once the patient has gained 120 of flexion they can use the box for moderate speed strengthening workouts.
  • As the patient progresses, other exercises in this stage might include wall squats, leg presses and calf raises, swimming, and core strengthening exercises or hip strengthening exercises using a band.
  • Patients will follow-up with their surgeon 3 weeks after surgery to check progress on fully extending the leg, ability to put full weight on the brace, active quad contraction, ability to perform straight leg raise and a minimal amount of less swelling.

Phase III: Static Conditioning

Usually by 6-8 Weeks After ACL Surgery patients should be able to have full flexion to 135 degrees, be able to consistently use the weight room and moderate speed strengthening training or agility and sport specific drills. Exercises in Phase III include daily core, back and hip exercises to promote core stability and control.  Static closed chain strengthening exercises including single leg squats and lunges focusing on good form then progressing to standing on an unstable platform.

If you have questions about ACL Preservation or recovery contact Dr. Goradia with G2 Orthopedics and Sports Medicine.  Or read more G2 Patient Testimonials.