Adhering to your ACL rehabilitation protocols is a key driver of achieving your ACL recovery goals!

• There are not too many injuries in sports that are more devasting than an ACL tear.   An ACL injury can bring a sudden halt to a persons sporting career and sometimes even end it.
• In this article, we are going to discuss some of the key fundamental ACL rehabilitation protocols that are required to kick start your recovery in the early stages after an ACL operation.
• These ACL rehabilitation protocols will help get your recovery off to a strong start and set the foundations for restoring knee functionality and stability moving forward.
• Further, you will learn some of the important habits and routines that you need to establish immediately following surgery (if not before your surgery as part of your ACL prehab) that will also apply to later phases in your recovery.
• There is no doubt that you can make some quick improvements to your knee functionality within the initial days and weeks following an ACL operation by following the protocols and exercises recommended by your surgeon and physio.
• In fact, it is important that you meet specific knee functional goals early in your ACL surgery recovery otherwise you may risk a poor rehabilitation and potentially corrective surgery.

Note: ACL reconstruction surgery is an elective procedure and it is wise to proceed with caution before electing to have an operation.

6 key ACL Rehabilitation Protocols 

We recommend 6 ACL recovery protocols to follow in the early weeks post ACL surgery that will provide the foundations for a strong and robust rehabilitation going forward.

ACL Rehabilitation Protocol 1: Start your rehab as soon as possible

• Your ACL rehabilitation exercises should commence as soon as possible.  Ideally, this would include undergoing rehabilitation prior to ACL surgery as well.
• In terms of post-surgery rehabilitation, commence almost as soon as you wake up after the surgery.
• A hospital physiotherapist will be available to instruct your exercises in the first 1 to 2 days.
• The main emphasis will be to immediately begin flexibility and mobility movements as advised by the physiotherapist or surgeon.

ACL Rehabilitation Protocol 2: Exercise 3 to 4 times per day

• Initially, your surgeon or therapist will provide exercises for you to follow at home in the first one to two weeks post-surgery.
• The frequency of exercises required for post ACL surgery is recommended at 3 to 4 times per day.
• There should be little or no knee pain with your workouts.  If you are experiencing pain with any of the exercises you have been recommended it is advised that you stop and choose an easier or abbreviated exercise to perform.
• It is important to protect the new ACL graft at all times and if you are experiencing pain with any of your exercises then there is the potential that you are overdoing it.

Within the first two weeks following surgery you should focus on performing the following daily exercises:

• Achieve full knee extension and locking of the knee (straightening out)
• Improve knee flexion on the bad leg to about 110 degrees which will be less than the non-operated knee.  Knee flexion on your operated side may be limited by swelling hence the importance of regular icing to reduce this as much as possible
• Active strengthening of the quadriceps muscles

For more information on specific exercises to complete during the different stages of your rehabilitation please visit our ACL recovery blog which contains a wide range of informative articles specific to your ACL injury.

ACL Rehabilitation Protocol 3: RICER

• RICER is an acronym that stands for Rest, Ice, Compression, Elevation, and Referral.
• RICER is a proven method for helping with the management of blood flow and swelling to an injured body part.
• It is very important to reduce the level of inflammation and swelling after ACL surgery as much as possible in your reconstructed knee.
• Following the principles of RICER as detailed below is particularly important in the first 48 to 72 hours after surgery but should however continue as you progress with your recovery.

Rest:

• Limit any sudden movements or twisting. As not to aggravate or risk re-injuring your new ACL graft

ICE:

• Generally speaking, try to ice your knee as much as possible.  At a minimum aim for at least 4 to 5 times a day and after each exercise workout

Compression:

• Keep your knee wrapped in compression sock or similar type of bandage as which helps to restrict the leakage of fluid from damaged capillaries.
• It is recommended that you continue to wear your bandage during the day for up to 8 weeks.  At night the bandage can be removed from about 2 weeks post surgery.

Elevation:

• Where possible keep your knee elevated during periods of rest.  This is also a highly effective method for controlling knee swelling after ACL surgery.
• Keep your injured leg elevated as much as possible by lying on the floor/couch with sufficient support under the knee such as a towel or pillow.

ACL Rehabilitation Protocol 4: No Harm to ACL

• There are a number of key precautions that you need to be aware of post ACL reconstruction surgery.
• Most importantly do no harm or damage to your ACL knee post-surgery.
• In particular, it is very important to avoid loosening or rupturing your new ACL graft.
• In this sense, it is advisable to avoid open kinetic chain exercises such as leg extensions as this may lead to stretching or loosening of your ACL graft until advised by your physio.
• It is also very important to ensure that all exercises and movements have minimal or no pain in your reconstructed knee.
• You should also ensure that your knee is well supported at all times and avoid any sudden movements or twisting.
• Your new Anterior Cruciate Ligament graft is vulnerable in particularly within the early weeks and months following your operation.
• If an activity is causing significant discomfort then stop immediately and choose an activity that is more comfortable.

ACL Rehabilitation Protocol 5: Self Education

• The value of self-education is often underestimated but yet it is still a very important aspect of your successful ACL rehabilitation.
• It is important that you become highly informed on the ACL surgery recovery protocols as soon as possible to ensure the best opportunity for your successful ACL rehabilitation.
• Your education is an ongoing process and needs to continue into the long term for the best results.
• You should prepare yourself for your ACL recovery timeline to take as long as 9 to 12 months.

ACL Rehabilitation Protocol 6: Supportive Equipment

Knee brace

• Whether or not you need to wear a knee brace either before or after ACL surgery is going to come down to your surgeon and physio’s preferences.
• Some surgeons advise that a knee brace is not normally required.  In fact, some suggest wearing a knee brace may actually inhibit recovery.
• Other surgeons will advise you to wear a protective knee brace for the first one to two weeks of your ACL rehabilitation to assist with walking, to provide a level of comfort and for the safety of your knee.

Crutches

• It is important to use crutches to assist you with walking after ACL surgery.  You should aim to gradually reduce your reliance on the crutches as you feel more comfortable.
• The use of crutches is generally recommended by most surgeons and physios to assist with walking.  Walking is possible almost immediately after surgery with the aid of crutches.
• You should continue to use crutches until you feel comfortable enough to walk without them however this is likely to be a gradual process over one to two weeks.

What is the overall goal of ACL reconstruction surgery?

• The long term target for your newly reconstructed knee is ultimately to return your knee stability and function back to similar levels as before your injury (importantly with minimal risk to rupturing your new ACL graft).
• In the early stages after your ACL reconstruction surgery, it is critical to restore full knee extension, reduce swelling and regain quadriceps control.
• We recommend six ACL protocols (as discussed above) to follow in the early stages after surgery that will provide the foundations for a strong recovery.

What can you expect in the first 2 weeks after ACL surgery?

• Following an Anterior Cruciate Ligament operation when you wake up in hospital your injured knee will typically be heavily swollen and immobile.
• Over the course of the next few days a significant focus is placed on reducing the swelling and phase 1 exercises which is likely to improve your mobility in the bad leg significantly.
• Once the surgery is complete a hospital therapist will be on site to guide you through your initial ACL knee exercises that you need to commence immediately.
• It is very important that you follow these exercises recommended by your surgeon and therapist to ensure that sufficient progress is made on your ACL surgery recovery in the early days.
• Post surgery, the first two to three weeks are considered to be one of the most important periods of rehabilitation within your ACL recovery timeline.
• By adopting a disciplined approach to your rehabilitation program you will give yourself the best chance of a full recovery.

Summary of ACL rehabilitation protocols to “kick-start” your recovery

• The main objective of your ACL surgery recovery within the first two weeks of rehabilitation post surgery is to reduce the amount of pain and swelling within the reconstructed knee, restore quadriceps control, and knee flexibility.
• This includes performing weight bearing, muscle toning and flexibility exercises.
• Your goal within the first few weeks is to achieve full leg extension, increase quadriceps muscle function and at least 110 degree flexion.
• Excessive motion or bending of your repaired ACL knee is not recommended as to limit risk and prevent your new ACL graft from rupturing.
• It is also important that you educate yourself on appropriate ACL rehabilitation exercises and protocols (which can also start prior to you going in for surgery).

Final Note

Following on from the early stages of your ACL tear recovery post surgery, you will need to continue to extend your program to include more specific and advanced ACL rehab exercises.