After ACL Surgery: Recovery and Physical Therapy

If you've been told you need ACL surgery, you're probably wondering what to expect. How long will it take to recover, and how is physical therapy involved? Here's everything you need to know. 

ACL surgery: What is involved? 

The ACL, or anterior cruciate ligament, is the central ligament in your knee. It is tissue that connects the thigh bone to the shin bone, and that helps stabilize certain knee motions.It’s especially pivotal for quick directional changes, jumping motions, and landing, as is needed in several sports.

If you've been told you need ACL surgery, that ligament has probably been completely torn. Or, it may have fallen off the bone.

During ACL surgery, a surgeon uses tissue from another part of your body, or from a tissue donor, to reconstruct the damaged ACL. If the ACL fell off the bone, they'll repair and reattach it.

Recovering from ACL surgery: When can I start putting weight on my leg?

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Usually, you'll be able to put weight on the affected leg within 24 hours of ACL surgery. But you definitely won't be able to return to your normal physical activity levels for a while. It usually takes around 6 to 9 months of focused rehab and recovery – including physical therapy – before you can do physical activity at your normal strength. The exact recovery time will depend on the sport or type of activity you seek to get back to.

Don't try to rush into resuming your sport, and don't expect your normal strength and agility to return without rehab. Even with a stellar surgeon and a successful operation, you need to dedicate yourself to your physical therapy routine in order to fully recover within the 6-9 month timeframe.

Andrew Ghaly, physiotherapist at Kinetic Labs, shares his recovery journey after ACL surgery to give you an idea of what to expect: 

ACL surgery recovery: The role of physical therapy 

A physical therapist will prescribe, and guide you through, the exercises you need for ACL rehab. You can – and should – start your post-surgery physical therapy as soon as the initial swelling and pain from the surgery decreases. This should happen within a week of the surgery. Your physical therapist will start you out with exercises that improve your strength, stability, and range of motion in the knee area.

Usually, you'll start physical therapy before your ACL surgery, to help get your body ready for the surgery. This is often called "prehab." During prehab, a physical therapist will help you cut down on swelling, strengthen your knee, work with you on walking, and help you with your range of motion, to promote a successful recovery after surgery with minimal strength loss.

ACL recovery timeline

What to expect at different points in your ACL recovery process? Here's a rough timeline.

Keep in mind that this is a rough timeline, based on exercises commonly prescribed by physical therapists at different stages of recovery. Every recovery timeline is slightly different, and the timeline for starting different exercises may vary.

Day after surgery

• Within the day after surgery, you should be able to start walking. But you'll use crutches, because of the pain and swelling from the surgery.
• You might be given a knee brace to wear along with the crutches, but this depends on your provider.
• You'll start taking ibuprofen, or another anti-inflammatory medication, to help you reduce the swelling and manage your pain.
• You might be given simple, at-home exercises for the knee, to move it around between surgery and when you start physical therapy.
• You’ll need to keep the dressing on for two days, and you won’t be able to get your leg wet until the dressing is removed.

First two weeks after surgery 

• You'll begin physical therapy within the first week after surgery. During the first two weeks, your physical therapist will help you regain range of motion in your knee (up to a 90-degree bend), strengthen your quadriceps and other muscles around the knee, protect the graft, and get rid of swelling.
• You might notice stiffness or tightness in the knee, but it's important to work through this with your physical therapist so you can work towards recovery, regain range of motion, and reduce your risk of scars.
• Some physical therapy exercises you can expect during this time period include:
• Ankle pumps
• Patellar mobilizations (where you gently move your patella with your hands)
• Heel slides with a towel
• Knee flexion extensions
• Supine hamstring stretches
• Extension stretches (low intensity)
• Calf raises
• Quad sets
• Supine knee extensions
• Hip abductions
• Isometric knee extensions
• Usually, you'll need to use crutches for 7-10 days, or until you can walk comfortably without them. 

Your physical therapist will show you how to put ice on your ACL, and use compression and elevation, to help manage the swelling.

• If you're wearing a knee brace, your surgeon or physical therapist will let you know how long you're expected to wear it (this varies based on your situation). 
• You'll take ibuprofen, or another anti-inflammatory medication, to help you reduce the swelling and manage your pain.
• If you drive, you can usually resume driving by the second week after surgery, assuming you're off the crutches. But before you get back behind the wheel, you'll need to regain enough strength from your physical therapy exercises to be able to control the pedals.
• You’ll need to avoid full knee bends and twisting movements.

Approx. 3-5 weeks after surgery

• At this point, you’ll start increasing your activity under your physical therapist’s guidance.
• You’ll start to move back to walking without assistance (without using a brace). 
• Physical therapy during this time will focus on regaining full range of knee motion, strengthening the knee muscles with resistance and light weights, working on endurance and balance, and protecting the graft from stress.
• Your persistent swelling should be gone at some point during this stage, but you may have some swelling after exercise.
• In addition to exercises you’ve already started doing, some physical therapy exercises you can expect  during this time period include:
• Using resistance bands and light weights
• Using the quad bike
• Using a step machine or cross trainer
• Gentle stretching of muscles (standing and prone quad stretches, plus kneeling hip flexor stretches)
• Step-ups
• Hamstring curls
• Partial squats, ball squats, and/or mini squats
• Bridges
• Hip hikes
• Balance exercises

Your physical therapist will make sure you have the proper alignment when you walk.

• You’ll need to avoid full knee bends and twisting movements.

Approx. 6-8 weeks after surgery 

• Physical therapy during this time will focus on regaining or maintaining full range of knee motion, further strengthening the knee muscles, avoiding pain and swelling after exercise, promoting proper movement patterns, and continuing to protect the graft from pain and stress.
• Your ACL is healing to the point that it can handle some more force, so it may feel like your mobility is improving a lot.
• You can usually start cardio exercises around this time.
• In addition to exercises you’ve already started doing, some physical therapy exercises you can expect  during this time period include:
• Using the elliptical
• Water exercises, including flutter kicking
• Using leg-focused gym equipment for strengthening
• Chair squats
• Lateral lunges
• Romanian deadlifts
• Step-ups and step-downs
• Single leg presses with some weight bearing
• Slide board lunges
• Squats with one leg
• Wall slides with one leg
• Other knee exercises for strength and range of motion
• Progressing in balance exercises
• You’ll need to avoid full knee bends and twisting movements until your physical therapist gives the OK.

Approx. 2-3 months after surgery

• Physical therapy during this time will focus on strengthening and power within the core and leg, as well as maintaining full range of motion and using proper movement patterns.
• You’ll continue the exercises that you started between 3 and 8 weeks after surgery.
• You’ll be able to start some sport-specific training, if you’re working towards resuming a sport.
• You may begin some plyometric exercises, including jump exercises. 

Approx. 3-5 months after surgery

• Physical therapy during this time will focus on strengthening and power within the core and leg, as well as working towards your return to sport or full physical activity.
• You'll continue exercises you began earlier in the rehab process.
• Around 4 months after surgery, you may be able to start running – if you have enough range of motion, no swelling, and enough quadricep strength.
• If ready, you’ll work through a running program under your physical therapist's supervision.
• You’ll also work through a plyometrics program and an agility program.
• Supervised endurance training is also common during this period.
• You’ll continue a sport-specific training program.
• You’ll start some pivoting exercises around 5 months after surgery. 

6-9 months after surgery 

• Physical therapy during this time will focus on returning to sport or full physical activity.
• You’ll work through multi-plane plyometrics (like jumping exercises) and agility exercises. These will be tailored to your sport, if you’re an athlete.
• You might also work on hard cutting and pivoting, if needed for your sport or type of activity.

Return to sport or full activity

• At 6-9 months after surgery, your physical therapist will clear you to return to your sport (or to unrestricted physical activity) as long as you have full range of motion, have no pain or swelling, and pass a functional assessment. 
• If you’re returning to a sport, you’ll start with no-contact practice, then full practice, then full competition. 

How to encourage the healing process at home

• Do home exercises as often as your physical therapist recommends them.
• Use ice and anti-inflammatory medicine to help reduce swelling, as advised by your physical therapist.
• Elevate your leg as much and as often as you can.
• Try massaging the kneecap, around the knee joint, if your physical therapist advises this.
• Don’t push yourself too hard – know what it’s safe to do, and what movements you should hold off on at your recovery stage, based on your physical therapist’s guidance.

Trust PeteHealth for ACL rehab

Looking for a physical therapist to guide you through your upcoming rehab after ACl surgery? PeteHealth is the trusted physical therapy solution that you can access on your schedule, bringing you the care you need wherever you need it – including your home or office. Our licensed physical therapists are at the top of their profession, and we accept most insurance carriers.

PeteHealth makes tailored care even easier for patients with PeteDME, which offers custom fit durable medical equipment (DME) – like crutches and braces – prescribed by your PeteHealth PT to address your unique needs.

Finally – the all-in-one, professional, convenient approach to physical therapy that you deserve with PeteHealth and PeteDME. 

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All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship.

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