ACL Surgery Rehabilitation

Anterior cruciate ligament (ACL) reconstruction surgery is done to recreate the torn ACL ligament using grafts. The is performed using an arthroscope that utilizes key-hole incisions. The rehabilitation after ACL surgery forms an important part of recovery. Non-compliance with rehabilitation protocol may be linked with poor outcomes of the surgery and continued pain and stiffness.

Intraoperative image showing ACL reconstruction.

Intraoperative image showing ACL reconstruction.

Phase (I) Initial postoperative period (0-2 weeks)

The rehabilitation protocol in the initial four weeks of the surgery is aimed towards graft protection, reducing pain and swelling, improving flexibility and muscle strength. A knee brace is usually worn in the first 4-6 weeks while standing and walking.

Walking is permitted with the use of crutches in the first few weeks with weight-bearing as tolerated by the patient. The brace may be taken off while bathing and during exercises. The brace may be locked at first and as the patients slowly gained confidence with therapy and standing, the brace may be unlocked and finally taken off.

While navigating stairs, patients are encouraged to place their normal (non-operated) knee first on the step and the operated knee first along with the crutch while coming down.

The patient is advised to maximize the effort to try to straighten the leg completely (or equal to the other leg). The patients are encouraged to try to bend their knee to 90 degrees in the first 10 days.

Stretching of the knee to improve extension may be done using prone hang, prone hang involves lying with your abdomen touching the bed with gradually shifting the legs below the one of the bed.

Instruments used in knee arthroscopic surgery.

Instruments used in knee arthroscopic surgery.

Strengthening exercises such as quadriceps and hamstring exercises are encouraged. The quadriceps muscles are present in front of the thigh and help in keeping the leg straight. The patients are advised to try to press the back of their knees to the bed while trying to contract the thigh muscles. The exercise is repeated in sets with incremental repetitions. Straight leg raise exercise may be done to increase the strength of the quadriceps.

Ankle pumps involve trying to push the ankles down and holding in the position for a few seconds. Multiple repetitions are done and ankle pumps not only help in building the strength of calf muscles but also help in preventing the incidence of deep vein thrombosis. The above exercises may be performed with the assistance of the therapist as well.

The patients are also advised to move their kneecap (patella) using their hands. Mobilization of the patella prevents the formation of adhesions that may cause stiffness. Swelling after ACL reconstruction is normal and may be managed by leg elevation above the heart level and regular icing. Compression with an ace bandage is also used to reduce the incidence of swelling.

Phase (II) 2-5 weeks post-op

Towards the end of 5 weeks, depending upon the progress, the patient may usually walk without the crutches and a knee brace. The stretching and exercise regime is further progressed with advanced exercises. The patients may use stationary bikes for range of motion exercises. Hamstring and quadriceps exercises may be done in the form of hamstring curls and mini squats. Balancing may be improved with the practice of a single-leg stance.

Phase (III) 5-8 weeks post-op

Range of motion, stretching, and strengthening exercises are continued. As the level of exercise increases, the patients are advised to avoid exercises that may precipitate pain and swelling. Exercises may be performed with equipment under the supervision of a therapist. At the end of phase 3, patients are able to walk normally without assistance and demonstrate a range of motion equal to the other knee.

Phase (IV) 8-12 weeks post-op

The patients are encouraged to safely transit to submaximal sports and athletic activities. The level of strength training and stretching is further advanced to build muscle and improve balance. All the activities are done in a safe manner when there is no associated pain.

Phase (V) 5 months post-op

Running may be resumed along with other cardiovascular exercises. The strength training and stretching program is continued. The patient’s progression is actively monitored by the physical therapist and the surgeon.

Phase (VI) 6 months post-op

The patients are allowed to safely return to full sports or athletic activities.

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.