What to Expect after ACL Surgery

Are you planning to have an anterior cruciate ligament (ACL) repair and wondering what to expect after ACL surgery and during your recovery process?

Are you currently rehabilitating your knee after ACL reconstruction and wondering if you are doing the right things?

Are you curious about your progress and whether or not you are “on track” with your recovery?

This is a guide on what to expect after ACL reconstruction surgery. It will help to answer these questions and make sure you are getting the most out of your rehab.

Rehabilitation after ACL reconstruction should be milestone based as opposed to time based. Too often, we hear about athletes reinjuring or retearing their newly reconstructed ACLs upon returning to running and/or sport simply because 6 months had passed and they thought they were ready.

Current evidence, however, suggests that an athlete’s rehab protocol should progress ONLY in response to achievement of measurable, objective outcomes, and not due to time lapsed since surgery. 

Tips for your recovery from ACL surgery:

1. Get your knee straight! Focus first (2-3 weeks) on regaining full, end range knee extension and flexion can progress more gradually.

2. Let pain and swelling be your guide. Significant pain and swelling are indicators that your knee isn’t tolerating the amount of load you are applying to it.

3. Use good form and proper technique as instructed by your physical therapist. Pay attention to how you walk, what position you sleep in, and what muscles you activate during exercise to prevent development of compensations that you will have to correct down the line.

4. Build your tolerance to plyometric loading and running gradually. If you apply high impact forces too quickly or too early, you could end up delaying your healing process.

5. FINISH THE MISSION! The last ⅓ of your rehab protocol is arguably the most important with respect to successfully returning to sport, reducing the chance of reinjury, and maintaining healthy knees long term.

What are the phases of recovery and how do you know when to progress?

Pre-op Phase: Injury recovery & readiness for surgery 

While you might be eager to have surgery as soon as possible, it’s important to allow the knee to have time to settle from the injury and regain some strength and range of motion, prior to surgery.

Criteria to progress: 

• Eliminate swelling

• Regain full ROM

• Regain 90% strength in quads and hamstrings compared to the other side

Phase 1: Recovery from surgery 

For the first two weeks after ACL surgery, it’s important to let your knee settle and regroup from the trauma of surgery. Place your focus on performing gentle range of motion and quad setting exercises to get the quad firing again. Be sure to ice and elevate your knee to modulate your pain, as needed.

Criteria to progress:

• Regain full extension (full flexion with come gradually within the first month, but knee extension ROM should be regained ASAP)

• Settle the swelling

• Get the quad firing again

Phase 2: Strength & neuromuscular control 

Once you have regained your full ROM and have gotten the quads to begin firing reliably, you are ready to begin working on regaining strength and neuromuscular control on your surgical side. Listen to your knee as you progress through this phase. Pain and increased swelling are signs that your knee is not tolerating the loads being placed upon it and should be used as a signal to decrease the intensity of your training.

Goals of Phase 2:

• Regain single leg balance on affected side 

• Shoot for 45 seconds with eyes open and 10 seconds with eyes closed

• Regain muscle strength within 85% of the unaffected side

• This can be assessed through isokinetic testing or more easily and readily through performance based outcome measures including single leg squats from a chair,  single leg bridges, calf raises

• Regain double limb functional strength

• Aim to be able to back squat 1.5x bodyweight

• Aim to be able to single leg press 1.5x bodyweight

Phase 3: Running, agility, and landings 

Once you have regained the majority of your lower extremity muscle strength, it’s time to incorporate agility training, plyometric loading, and running into your rehabilitation protocol.

Goals of Phase 3:

• Develop excellent form with single leg hopping drills and aim to be within 95% of the unaffected limb during the single leg hop, triple hop, and triple crossover hop

• Hone in your landing mechanics (box jumps, box drops, hurdle jumps with single and double leg landings)

• Reintroduce and master change of direction and deceleration drills (slalom runs, shuttle runs, ladder agility drills)

• Resume straight line running using intervals to guide your time and distance, initially

• Regain double limb functional strength

• Aim to be able to back squat 1.8x bodyweight

• Aim to be able to single leg press 1.8x bodyweight

Phase 4: Return to sport 

Once you are able to perform single leg hopping drills within 95% of the unaffected limb, you are ready to progressively incorporate “game-like” movements and drills into your rehabilitation. During this stage of recovery, which usually occurs around 9 months post-operatively, you should also be performing total body exercises that you would have been focusing on pre-injury.

The most important criteria to determine whether you are ready to return to sport or not is your state of mind. If you are confident and eager to get back out on the field, court, road, etc. and your knee has been progressively and consistently exposed to all of the forces that you might encounter when you return to play, you are ready!

Looking for performance rehab for ACL surgery in Jacksonville Beach, FL?

If you’re looking for personalized, one-on-one sessions to address your needs after an ACL surgery, we provide performance physical therapy services to active adults and athletes in the Jacksonville Beach area.

If you’re looking for providers who will listen to you and help you get the most out of your post-op journey and get you back to playing your sport, we offer the highest level of ACL rehabilitation in Jacksonville Beach, FL. Your personal ACL journey can last from 9-18 months and having proper guidance by an expert is absolutely crucial to getting you back on the field, playing at a higher level than before, and being completely confident in your knee. Instead of being one face in a crowd of patients, our services are customized to YOUR NEEDS.

Get started today by booking a discovery call.