How will I recover from Anterior Cruciate Ligament (ACL) Surgery?

Torn ACLIt normally takes several months, and in some cases up to a year, in order to fully recover from anterior cruciate ligament (ACL) surgery. Recovery is affected by the severity of the injury, the extent of the surgery, and the diligence with which one follows their rehabilitation program. Physical therapy rehabilitation is essential to regain normal range of motion and to resume pre-surgery activities. Physical therapy treatment plans will differ somewhat, based on what type of graft was used during surgery and whether other parts of the knee, such as the meniscus, need to be repaired.

There are different treatment plans and protocols, but a program should include exercises for strength and flexibility, endurance, coordination, and agility, a well as restoring normal gait patterns and improving proprioception and balance. Generally, as sessions with a physical therapist decrease, patients must perform more exercises at home.

Immediately following surgery, patients are advised to work on fully extending their leg. This can be accomplished with the aid of cold compression therapy, such as a Cryo-cuff. Cold compression and icing controls swelling and reduces pain. Active assist and passive range-of-motion exercises help with knee extension. Also, bracing can be helpful, and most surgeons will give a brace to a patient to restrict range of motion.

Physical therapy usually commences one to two weeks after surgery. Early sessions will typically involve range-of-motion exercises and soft tissue treatments that may include manual manipulation. After seven to ten days, patients should be able to stand without crutches, depending on the type of surgery done and the surgeon’s recommendations. Knee extension is critical to a successful recovery from ACL surgery and will remain the focus for the first week or two after surgery, while fully bending the knee is a more gradual process that will be accomplished after four to six weeks. It is important to maintain patellar mobility through soft tissue mobilization, especially if a patellar tendon graft was used for surgery. If a hamstring graft was used, no active hamstring exercises are recommended before two weeks.

Patients may typically begin driving two weeks after surgery or once they are off crutches and have adequate strength and mobility. It also depends on which leg has been operated on and a patient’s individual recovery.

Between three and six weeks after surgery, therapists will begin implementing strength exercises that may include light weights and sports bands, as well exercise on a stationary bike or treadmill to improve endurance. Having a full range of leg motion is emphasized at this point and some sport-specific activities can commence.

During weeks seven through 12, patients may begin increasing their activity levels. Some may begin jogging around the twelfth week. Other activities may include jumping rope and outdoor cycling. Sport simulating activities may also be used, such as figure-eight drills and plyometrics.
For the next four to seven months, patients can progress from sport simulating activities to eventual participation in normal sports activities. However, this period may be the most difficult for many patients because while the knee may feel normal, it is important not to put too much stress on it too soon. Returning to unrestricted sports activities will depend on a patient’s progression through physical therapy and consultations with their surgeon.

ACL surgery recovery has a high success rate if patients take care to follow their physical therapy rehabilitation program. The timeline to recovery is merely a guide and varies from case to case.