Your ACL recovery timeline and how fast you can return to the sports field will largely depend on how you progress with your exercises and how your knee responds to the surgery
The most important factors with your ACL recovery include achieving full knee extension and good quadriceps activation which needs to be a key focus area early in your timeline.
The speed of your knee recovery will largely depend on how your knee responds to the operation plus the duration and frequency of your exercise rehabilitation sessions – as recommended to you at your post operative appointments.
How long it takes you to recovery from ACL surgery is also dependent on other factors such as age, fitness levels and the structure of the knee. The impact of these factors on your recovery can vary from person to person.
Your initial progress in the first week is likely to be quicker than you think and will possibly include taking steps without crutches in a matter of days.
You should aim to continuously improve your knee functionality by gradually increasing the physical intensity of your rehabilitation exercises and maintaining a structured recovery program.
The intensity of your recovery exercises should essentially be guided by the level of pain and swelling in your knee.
Maintaining your motivation through each stage of your ACL recovery will also be an important factor to regaining full strength and achieving a full knee recovery.
When can you return to playing sport
In terms of sport, generally most patients are able to start some basic sporting activities after 4 months. At 6 months progressing into specific training and drills with a with view to return to sport at 9 to 10 months.
Before you return to playing sport you should ensure that your recovery goals have been met. If you have not restored good strength and full movement in your knee you may benefit from additional rehabilitation (see below for more information on returning to sport).
5 key ACL recovery timeline stages for sports athletes!
The following ACL recovery timeline for simplicity has been split into 5 key phases which includes:
- Commencement Stage 1 from 0 to 2 weeks
- Build Stage 2 from 2 to 12 weeks
- Advance Stage 3 from 3 to 4 months
- Preparation Stage 4 from 4 to 6 months, and
- Return to Sport Stage 5 from 6 to 9 months
This timeline is designed to guide you with your recovery following an Anterior Cruciate Ligament reconstruction that supports the advice provided at your post-operative appointments.
Your ongoing rehabilitation can be undertaken either independently or under the guidance of your physiotherapist.
It is absolutely normal to find that you may progress faster or slower than the timeline guide below as recovery times can vary from person to person.
ACL Recovery Timeline: Commencement Stage 1
0 to 2 Weeks After Surgery
The first stage of your ACL recovery timeline is referred to as the Commencement Stage and whilst all 5 stage are important, the Commencement Stage is critical to setting the foundations for a successful recovery.
Your post-operative rehabilitation begins immediately after surgery. Following surgery you will return home from hospital after 1 to 2 days. Although sometimes if you have surgery in the morning you may return home that same afternoon.
It is important that you do not delay rehabilitation and begin exercises and your ACL recovery protocols such as management of swelling as soon as you awake from the operation. Your surgeon and hospital physio will be on site to get you started.
At this point your key goals in the first few critical days and up to two weeks after surgery include:
- Returning normal range of motion especially knee extension (straightening). In other words achieving and maintaining full extension of your knee. Being able to fully lock your knee is highly critical to the success of your ACL recovery in the early stages
- Maintaining that knee locking capability is also very important throughout the course of your recovery and to enable a return to sports and full activity later in your timeline
- Reduce swelling and inflammation in the knee as much as possible through regular icing, elevation of the knee and wearing a compression bandage
- Full quadriceps activation which commences by regaining function of your quadriceps at the front of your thigh
Also within the first two weeks following your ACL operation you should aim to:
- Focus on walking after surgery in a normal way. Initially you are likely to require crutches and a good progression is to move from 2 crutches to 1 crutch within about a week after surgery. Steadily you should aim to improve your walking gait within the first few weeks and reduce your reliance on crutches
- Many people are off the crutches within 2 weeks after surgery
- Limit any sudden movements or twisting on your knee in particularly in the early stages when knee swelling and tenderness are prevalent
- Be sure to rest your body and sleep in a way that you find the most comfortable. Receiving adequate amounts of rest and sleep is another important ingredient to your ACL recovery
- You should basically aim to be resting at home in the first week post-surgery by keeping the knee as elevated as much as possible.
- In the second week you can gradually come off the crutches but essentially still staying at home and limiting any uncomfortable movements
- In these early phases of your ACL recovery timeline, it is also a good opportunity to develop a strong recovery routine by completing the recommended exercises plus icing a minimum of 3 to 4 times a day. In fact try to ice as much as possible for 15 to 20 minutes at a time
It is important to note that the early stages of your recovery after surgery are one of the most critical stages of your rehabilitation. Understanding your ACL rehabilitation protocols is essential.
Unfortunately not getting this right could be detrimental to the long term functionality of your knee and possibly corrective surgery may be required.
ACL Recovery Timeline: Build Stage 2
2 to 12 Weeks After Surgery
The 2nd stage of your ACL recovery timeline is referred to as the Build Stage and has a strong focus on returning your knees strength, flexibility and range of motion. Plus building on and maintaining the gains made in stage 1.
After approximately 2 weeks post-surgery you will move into phase 2 of your ACL recovery timeline:
- In stage 2 it is important to continue with your phase 1 exercises (0 to 2 weeks as noted above) and gradually add additional mobility and strength exercises.
- This includes quadriceps and hamstring exercises as listed in your recovery program or recommended by your physio or strength & conditioning trainer.
- Be careful not to do any exercises which may loosen or stretch the new ACL. With all exercises be guided by the level of pain and swelling.
The key goals and activities for stage 2 rehabilitation include:
- Quadriceps strengthening to build on the gains made in phase 1. Which included full quadriceps activation. But at this stage leg extensions on the gym machine are not recommended
- Hamstring curls to develop strength within supporting muscle groups that will have naturally deteriorated after the operation
- Stationary bike with elevated seat. Gradually work towards improvements in flexion and range of motion
- At 5 weeks start a gym program to improve strength & mobility with specifically targeted exercises. Some of these exercises may be done from the comfort of your own home
- Swimming pool – including water walking and knee lifts designed to assist with weight bearing plus improving range of motion. Avoid kicking for 8 weeks
- Mini trampoline at 8 weeks post surgery
- Introduce specific exercises to improve balance such as shallow wall squats and transitioning from using 2 legs to 1 leg when you are comfortable
- Monitor pain & swelling on all exercises which includes continuing to ice after a workout or physical activity plus wearing a compression bandage for at least 8 weeks
ACL Recovery Timeline: Advance Stage 3
12 to 16 Weeks After Surgery
The 3rd stage of your ACL recovery timeline is referred to as the Advance stage as you begin to really increase the complexity and degree of difficulty of your rehabilitation exercises with a strong emphasis on improving your knee stability and balance.
The Advance phase also includes building further on the training exercises in stage 2 and taking those exercises to the next level of development.
Following on from stage 2 of your ACL recovery you move into phase 3 after approximately 12 weeks post-surgery:
- At this point some patients can struggle to maintain enthusiasm for their rehabilitation however it is important to continue exercising and progress your knee rehabilitation program.
The key goals and activities for Stage 3 rehabilitation at 12 weeks include:
- Continuing with your gym program for quadriceps and hamstring strength plus exercises to improve balance on your knee
- Additional exercises to improve functionality and balance in your knee include step downs and bridges
Stage 3, 12 week ACL exercise 1: Step Downs
Stage 3, 12 week ACL exercise 2: Bridges
- Once you are comfortable jogging on a treadmill or trampoline for 10 minutes you can progress to jogging in a straight line outside on a flat surface (jogging outside can become an option for you at approximately 3 months post surgery)
- Gradually building towards sprints when you feel comfortable
- Also introducing jumping and landing drills but be careful to use common sense and progress steadily
- It is also important to continue icing on a regular basis, reduce swelling and maintain your ability to fully extend your knee. Fully locking your knee was one of your key goals in stage 1.
As per all stages of your ACL recovery timeline be guided by the level of pain and swelling in your knee and continue to ice after exercise.
ACL Recovery Timeline: Preparation Stage 4
4 to 6 Months After Surgery
The 4th stage of your ACL recovery timeline is call the Preparation stage as this point most patients start to recommence basic sporting activities and prepares you for non contact drills.
Following on from stage 3 of your ACL recovery you move into stage 4 after approximately 4 months post-surgery:
- At this point in time you can commence sports specific drills such as shooting basketballs, kicking footballs, hitting tennis balls and hockey balls. Ensure that you progress gradually and use common sense.
The key goals and activities for stage 4 rehabilitation include:
- Introduce changes in direction whilst jogging
- Gradually increase sharpness and speed of turns
- Consider use of ACL specific programs designed to prevent injury but which are also very useful for preparing athletes for sport following ACL surgery. Below we provide an overview of these programs which will indicate whether or not you are ready to commence non contact drills
- Introduce drills and training specific to your sport
ACL Recovery Timeline: Return to Sport Stage 5
6 to 12 Months After Surgery
The final phase, stage 5, of your ACL recovery timeline is the Return to Sport stage.
Following on from stage 4 of your ACL recovery you move into stage 5 after approximately 6 months post-surgery:
- Stage 5 is essentially focused on preparing on your knee to play sport and returning to full training provided there is no swelling, excellent quadriceps strength and full knee movement
- At this stage it is important to remember that the speed of your recovery post ACL reconstruction surgery and return to sport will be different to other people depending on a number of factors (as mentioned above)
- It is important not to risk a return to sport if you have not completed your rehabilitation
- Therefore only prepare for a return to sport and move into Stage 5 once you are comfortable completing the exercises from the previous phases.
The key goals and activities for Stage 5 rehabilitation include:
- Non-contact sport specific drills or activities up to 6 months and potentially longer depending on the rate of healing of your knee
- Gradually build the intensity of your activities and sports specific training
- Returning to full activity or competition upon full ACL recovery
Reoccurring problems can occur as a result of poor fulfilment with your ACL rehabilitation. However the risks can be mitigated by following a structured weekly recovery program that starts from surgery all the way through to full knee recovery.
Can rehabilitation before surgery help with your ACL recovery timeline
A question that is often asked is whether ACL prehab prior to surgery can help speed up your ACL recovery timeline.
- Research studies have found that people who have maintained knee fitness and strength prior to surgery are more likely to advance their ACL recovery at a faster rate compared to people who did not perform knee rehabilitation before surgery
- As a result it is important to prepare your knee for ACL surgery ensuring that you can:
- Fully extend your knee
- Reduce knee swelling caused by the ACL tear injury
- Improve flexion and use the exercise bike
- Implementing some gym exercises as recommended by your physio or surgeon
- To some extent the amount of preparation required before ACL surgery will also be dependent on how long you have to wait before the operation. If you decide that ACL surgery is the right option for you
- Sudden changes in direction or pivoting should be avoided as this can cause the knee to buckle and damage to the knee cartilage as a result.
- Walking with an ACL tear and jogging in straight lines before surgery is certainly realistic for most people.
How Long Does it Take for the New ACL Graft to Heal?
- A newly inserted ACL graft can take as long as six months to regrow (however can take up to 3 years to complete 100% growth) and during that time you will have to be on restricted activity and undergo physical therapy in order to recover.
- Overall it is thought that an ACL reconstruction has as 82-95% long-term success rate according to a 2013 study published in the Journal of Bone and Joint Surgery.
When can you return to playing sport after ACL surgery
A return to sport takes place in phase 5 of your recovery.
Per above, your ACL recovery timeline includes recommencing some sports activities after 4 months, resuming training at 6 months with a view to returning to play sport at 9 to 10 months. You can expect improvements for another 6 to 12 months after that.
Returning to full intensity competitive sport is a gradual build that begins with:
- Recommencing basic sports activities after approximately 4 months and includes simple drills like hitting tennis balls or shooting basketballs
- Resuming sport specific training and non-contact drills at approximately 6 months
- Building the intensity of these drills into game simulation
- After approximately 9 to 10 months returning to sport and competition
- You can also expect further improvements for another 6 to 12 months with continued exercise and conditioning plus as your ACL graft gains more strength
This is a typical ACL recovery timeline for returning to the sports field however it will vary from person to person and it is important to progress at a pace that is comfortable to you.
Professional Athlete ACL recovery timeline
Despite having open access to gym and training facilities plus physios and sports trainers, there is no one fixed timeline for a professional athlete returning to the sports field.
In fact some professional athletes have been known to wait for 12 months or more following ACL surgery before they return to play competitive sport at the highest level.
This approach is often in recognition that playing sport at the highest level places significant demands on the body joints and extra time may be required to improve knee functionality to desired levels.
7 important factors to consider for planning and setting goals with your ACL recovery timeline
- If you want to feel confident returning to play sport and physical activity following ACL surgery then a detailed rehabilitation plan will help keep you on track and progressing faster towards your goals
- Following the correct ACL recovery protocols and a progressive set of exercises during all phases of your rehabilitation is very important to restoring your knee functionality back to optimal levels
- To fully rehabilitate your knee after ACL surgery requires ongoing persistence with your recovery. It is a good idea to actively plan each week and months rehabilitation activities in advance. It is not uncommon for rehabilitation to take you up to 6 to 12 months!
- After surgery review and monitor your ACL treatment plan on a regular basis with your physician. Commencing from the day you have the operation.
- Tailor your recovery plan to meet your individual circumstances as ACL recovery is highly individualistic. Be guided by the level of pain in your knee when progressing your exercise program.
- Ensure there is sufficient load and range of motion exercises applied to your knee which progressively increases the level of difficulty without causing pain
- Your rehabilitation plan should be designed to steadily increase your knees strength, flexibility and functionality on an ongoing basis.
Useful tips to help with your ACL recovery timeline
- After surgery, it is critical to start your ACL rehabilitation immediately after surgery.
- Most surgeons agree that you can shower straight away or within a few days after ACL surgery but be careful to keep the incision dry!
- You can drive after ACL surgery when you are confident and comfortable to do so. Importantly you must be able to brake quickly in case of an emergency.
- When recovering from an ACL reconstruction it is not uncommon to be unsure what your recovery timeline looks like but much can gained by learning about what you are required to do
- The most critical part of your ACL recovery timeline is to be able to fully lock your knee within 3 weeks and quadriceps activation. Other key objectives early in your recovery include reduce swelling, restore balance and return to a normal walking gait
- Crutches are likely to be required for the first 1 to weeks after surgery
- Depending on your surgeons preferences a knee brace may be required in the early stages of ACL recovery however more and more surgeons are moving away from recommending a knee brace for patients
- The ACL recovery timeline following a knee reconstruction can vary for each individual due to a number of complexities. This is due to factors such as your fitness levels, pre-existing injuries, the structure of the knee, your age and your propensity to complete a full rehabilitation program.
What is the 1 primary goal of an ACL Reconstruction
- Your key goal is to stop or prevent instability in the knee. That is effectively the primary reason for having an ACL reconstruction.
- As ACL surgery is almost always an elective procedure and one of the major considerations within the decision making process is to determine whether or not there is instability in the knee
- Often knee instability can be predicted immediately after the injury event and a decision to have an ACL reconstruction is therefore clear.
What are the goals of your recovery after ACL surgery
- As noted above your key goal of an ACL reconstruction is to prevent knee instability. After surgery, your goals within recovery are to regain range of motion and strength in your knee.
- To fully restore range of motion and strength in your knee there are a number of phases that you will need to progress through within your ACL recovery timeline.
- Above we discuss your ACL surgery recovery timeline and have split this into 5 key phases which should be completed in their entirety to give yourself the optimal recovery for both the short and longer term benefit to your knee recovery.
Consult your physician or surgeon to discuss your next steps.
5 Key Questions to Keep Top of Mind With Your ACL Recovery Timeline
- What is the primary goal of having an ACL reconstruction?
- What are the key phases of my ACL recovery timeline?
- What are the primary objectives within each key phase of my ACL surgery recovery timeline?
- How do I achieve the objectives of each key phases?
- When can I return to sport and how do I know if I am ready?
The answers to each of these questions are detailed above.
ACL Specific Programs to Prepare You for Non-Contact Drills
- There are a number of ACL injury prevention programs that are also very useful for preparing you for sport after ACL surgery
- Two of the more well recognised programs are called the FIFA 11+ and PEP programs
- If you can complete either of the FIFA 11+ or PEP programs comfortably then you can begin non contact drills and move on from phase 4 to phase 5 of your recovery
FIFA 11+ program to help you assess your recovery progress in phase 4
Although the program was designed for football it is also highly applicable to most sports that require pivoting or cutting movements.
- The FIFA 11+ is designed as a complete specific warm up program by the football medical centre of excellence. The program objectives include training muscle and joints to be less susceptible to loss of balance and falls
- As mentioned above, the program is also a particularly useful program for returning to sport after ACL surgery. If you can complete the 11+ program comfortably then you can commence non contact drills and move into phase 5 of your ACL recovery timeline
There are 3 core components to the 11+ program which in total take approximately 20 minutes to complete and includes:
- Running exercises in part 1 (8 minutes to complete)
- Plyometric strength and balancing exercises part 2 (10 minutes to complete)
- Further running running exercises part 3 (2 minutes to complete)
The 11+ program can be completed in approximately 20 minutes and implemented without any assistance nor any equipment except some markers.