What Are the Necessary Steps for Rehabilitation after ACL Reconstruction?

After undergoing anterior cruciate ligament (ACL) reconstruction surgery, a recovery period is required to ensure that the healing process is underway. 

Rehabilitation from this type of intervention begins once the patient wakes up in the recovery room. 

This process aims to protect the reconstructed ligament and gradually progress towards and achieve a pre-operation level of activity and motion in the knee.   

It should be noted that patients that have undergone additional surgical repairs in their knees (i.e., MCL or PCL surgery or repairs) will progress differently in their rehabilitation. 

  • In the first week following ACL reconstruction, patients are encouraged to lift their legs by themselves while lying on their backs. These leg raises address post-operatory stiffness issues and help manage pain. 
  • During the first weeks following the intervention, crutches are usually needed to alleviate the stress on the knee while moving. After this period, the patient can generally walk without the help of mobility aids.
  • Rehab sessions typically begin 1 to 2 weeks after surgery under the supervision of a physical therapist. During this period, weight-bearing may be allowed so long as the patient's meniscus wasn't also operated on during the ACL reconstruction procedure.
  • During the first couple of months of rehabilitation, a 0 to 140 degrees range of motion is an appropriate goal to strive for. 
  • Strenuous activity in the lower body that requires effort from muscles such as the quadriceps isn't recommended given the stress placed on the new ACL graft. Bike riding and leg presses using light weights are acceptable activities in the first 3 months after the intervention. These exercises allow the quadriceps to develop while using the hamstrings to alleviate the pressure on the reconstructed graft.
  • Running and swimming isn't recommended for up to 5 months, although swimming motions with the hands while not paddling is permissible around 2 to 3 months after ACL reconstruction. 

As the patient advances through the months of rehabilitation, strength and mobility exercises will gradually increase, adapting the reconstructed ACL to the efforts of active gameplay. Return to sports is aimed for at least 6 months after the surgery. However, due to the varying nature of every injury and procedure, a full recovery can take up to 9 or 12 months in some cases.