Your ACL recovery timeline after surgery includes 5 key phases to successfully return to sports and normal activities
ACL surgery is a serious operation that requires a significant amount of time to recover from. The ACL, or anterior cruciate ligament, is one of the four major ligaments in the knee that help to stabilize the joint. A tear in the ACL is a common injury, particularly among athletes who participate in high-impact sports.
ACL surgery typically involves grafting tissue from another part of the body to replace the damaged ligament. The recovery process is long and gradual, but it is important to follow your surgeon’s instructions and progress through each stage carefully in order to avoid further injury.
After ACL surgery, your goal should be to fully rehabilitate the knee in order for you to not only feel better but also return to sports and your normal activities. This process can take up to 12 months or more, which as a guide we summarise into 5 key phases!
The first phase of post-surgery rehabilitation is incredibly important, and it’s critical that you start right away! You’ll have a few objectives during this time, including reducing swelling; restoring balance (especially with your step), and locking your knee.
During this period, one focus should be on reducing swelling by applying ice packs or cold foods such as snow peas for 20 minutes every few hours while taking anti-inflammatory drugs if prescribed by your doctor, since it will help with pain management too.
The timeline guide below will help you to understand your recovery following an anterior cruciate ligament reconstruction and supports the advice given at post-operative appointments.
Stage 1 (1 to 2 weeks)
Your key goals in the first few critical days and up to two weeks after ACL surgery include achieving and maintaining full extension of your knee and being able to fully lock your knee.
The early stages of your recovery after an anterior cruciate ligament (ACL) knee surgery are one of the most critical stages of rehabilitation and should be approached with care.
A good progression is to move from 2 crutches to 1 crutch within about a week after surgery. Aim to be resting at home in the first-week post-surgery by keeping the knee as elevated as possible and limit any sudden movements or twists on your knee.
In summary, your key goals in the first two weeks after ACL surgery include:
- locking your knee
- reduce knee swelling
- return normal range of motion
- full quadriceps function
- return to normal walking gait
Stage 2 (2 to 12 weeks)
After approximately 2 weeks post-surgery, you will move into phase 2 of your ACL recovery timeline. Phase 2 has a strong focus on returning your knee strength, flexibility, and range of motion.
Quadriceps and hamstring exercises are core elements of your phase 2 recovery program.
In stage 2, it is also important to continue with your phase 1 exercises.
With all exercises, be guided by the level of pain and swelling.
Stage 3 (12 to 16 weeks)
Stage 3 goals from 12 to 16 weeks include continuing with your gym program and progressively increasing the level of difficulty of the exercises to improve knee functionality.
Stage 4 (4 to 6 months)
Your key goals in stage 4 include advancing your gym program, practising changes in direction, and training drills specific to your sport.
Stage 5 (6 to 12 months)
Your goals in stage 5, from 6 months onwards, include sports-specific activities, drills, and non-contact training. Gradually increase the intensity of your activities and sports-specific training.
Returning to full activity or competition upon full ACL recovery!
Each stage of your ACL recovery timeline is explained in more detail below.
What are the most important factors for advancing your ACL injury recovery?
The most important factors in your ACL recovery include achieving full knee extension and good quadriceps activation, which needs to be a key focus area early in your timeline.
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.
Throughout the duration of your recovery program, you should aim to gradually increase the intensity of your rehabilitation exercises.
Your ACL surgery recovery timeline and how fast you can return to your normal activities and sports will largely depend on how quickly you advance with your rehabilitation exercises and how your knee responds to the surgery. Recovery times can vary from person to person.
How long it takes you to recover from ACL surgery is also dependent on other factors such as age, fitness level, and the structure of the knee.
Maintaining your motivation through each stage of your ACL recovery will also be an important factor in regaining full strength and achieving a full knee recovery.
Your post-surgery rehabilitation can be performed independently or under the guidance of your physiotherapist.
When can you return to your sports and normal activities?
In terms of your normal activities or sports, generally, most patients are able to start some basic activities or basic sports after 4 months. At 6 months, they progress into specific training and drills with the view of returning to full activity or full sport from 9 to 10 months onwards.
Before you return to playing a sport, you should ensure that your recovery goals have been met. If you have not yet restored good strength and full movement in your knee, you may benefit from additional rehabilitation (see below for more information on returning to sport).
A detailed guide on each of the 5 Key ACL recovery timeline stages:
The following ACL recovery timeline, for simplicity, has been split into 5 key phases, which include:
- 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 Full Normal Activities or Sport Stage 5 from 6 to 9 months
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 five stages 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 the 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 managing 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 to a 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 begins with regaining quadriceps function 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 crutches within 2 weeks after surgery
- Limit any sudden movements or twists on your knee, especially in the early stages when swelling and tenderness are common
- Be sure to rest your body and sleep in a way that you find most comfortable. Receiving adequate amounts of rest and sleep is another important ingredient in 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 possible
- In the second week, you can gradually come off the crutches, but essentially, you will still stay at home and limit 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, failing to get this right could have a negative impact on your knee’s long-term functionality, necessitating corrective surgery.
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 knee 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 (0–2 weeks as noted above) and gradually add additional mobility and strength exercises.
- Quadriceps and hamstring exercises are core elements of your phase 2 recovery program. Your physio or strength and conditioning trainer can assist with designing the correct exercises.
- Be careful not to do any exercises that 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 build strength in supporting muscle groups that will have naturally deteriorated following surgery.
- Stationary bike with an elevated seat. Gradually work towards improvements in flexion and range of motion
- At 5 weeks, start a gym program to improve strength and 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 to help with weight-bearing and range of motion. Avoid kicking for 8 weeks
- At 8 weeks after surgery, use a mini trampoline for jumps (begin with caution)
- 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 and 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 “advanced 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 advanced 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 in your knee rehabilitation program.
The key goals and activities for Stage 3 rehabilitation at 12 weeks include:
- Continuing your gym program for quadriceps and hamstring strength, as well as exercises to improve knee balance
- Step-downs and bridges are two other exercises that can help you improve your knee’s functionality and balance.
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 build towards sprints when you feel comfortable
- Also, introduce 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 to 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 called the “Preparation Stage.” At this point, most patients start to recommence basic normal activities or sporting activities and prepare 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 the sharpness and speed of turns
- Consider using ACL-specific programs that are designed to prevent injury but are also very useful for preparing athletes for sports after 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 Full Normal Activities or Sport Stage 5
6 to 12 Months After Surgery
The final phase, stage 5, of your ACL recovery timeline is the “Return to Full Normal Activities or 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 primarily concerned with preparing your knee for full normal activities, sports, and returning to full training as long as 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 sports-specific drills or activities for 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 compliance 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, in some cases, people who perform rehabiliation before surgery have a faster rate of recovery after surgery.
- As a result, it is important to prepare your knee for ACL surgery by ensuring that you can:
- Fully extend your knee
- Reduce the swelling caused by the ACL tear injury in the knee.
- Improve flexion and use the exercise bike
- Implementing some gym exercises as recommended by your physio or surgeon
- The amount of rehabilitation required before ACL surgery will also be dependent on how long you are required to wait before the operation. Assuming 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 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. During that time period, you will have to be on restricted activity and undergo physical therapy in order to recover. The new ACL graft will continue to strengthen for up to 3 years post-surgery.
- Overall, it is thought that an ACL reconstruction has an 82–95% long-term success rate, according to a study published in the Journal of Bone and Joint Surgery.
When can you return to playing sports after ACL surgery
A return to sport takes place in phase 5 of your recovery.
Per above, your ACL recovery timeline includes resuming some sports activities after 4 months, resuming training at 6 months, with a view to returning to playing sports 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 process that begins with:
- Resuming basic sports activities after approximately 4 months and including 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 for you.
ACL Recover Timeline for Professional Athletes
Despite having open access to gym and training facilities, as well as physios and sports trainers, there is no set timeline for a professional athlete’s return to sports.
In fact, some professional athletes have been known to wait for 12 months or more following ACL surgery before they return to playing competitive sports at their highest level.
This approach is often taken in recognition that playing sport at the highest level places significant demands on the body’s joints and extra time may be required to improve knee functionality to desired levels.
Goal setting and planning your ACL recovery
- During your rehabilitation, it is recommended that you set goals for the type of outcomes that you are looking to achieve during and at the completion of each stage of your recovery.
- Continuously planning your exercises and activities during all phases of your rehabilitation will help keep you on track to restore your knee functionality back to optimal levels.
- This should include creating a weekly and monthly rehabilitation plan that lists your daily exercises, sets, and repetitions.
- It is important to get started with your rehabilitation immediately after surgery whilst in hospital. Your surgeon or onsite hospital physio will be there to assist you with your exercises in the first instance.
- When you return home from the hospital, review and monitor your ACL treatment plan on a regular basis with your physician.
- Tailor your recovery plan to meet your individual circumstances, as ACL recovery is highly individualistic. When you are progressing with your exercise program, you should be guided by the level of pain in your knee.
- 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 knee strength, flexibility, and functionality on an ongoing basis.
Practical tips for post-surgery ACL recovery
- 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 doing 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 of what your recovery timeline looks like, but much can be 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 of quadriceps activation. In addition, reducing swelling, restoring balance, and returning to a normal walking gait are also important early in your recovery timeline.
- Crutches are likely to be required for the first 1 to 2 weeks after surgery.
- Depending on your surgeon’s 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 level, pre-existing injuries, the structure of the knee, your age, and your propensity to complete a full rehabilitation program.
- 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, 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 the decision to have an ACL reconstruction is therefore clear.
- There are a number of factors to consider when determining if ACL reconstruction surgery is right for you. Click the heading above for more information.
What are the primary goals of an ACL reconstruction?
- As noted above, the key goal of an ACL reconstruction is to prevent knee instability. After surgery, your goals during 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 short and long-term recovery.
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 key objectives of each ACL recovery phase?
- How do I achieve the objectives of each key phase?
- When can I return to sport and how do I know if I am ready?
Educating yourself on ACL recovery protocols and timelines will generally help to improve your rehabilitation outcomes.
Specific 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-known 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 muscles 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 exercises part 3 (2 minutes to complete)
The 11+ program can be completed in approximately 20 minutes and implemented without any assistance or any equipment except some markers.
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