The recovery timeline for an ACL reconstruction surgery is based on multiple factors, including (but not limited to) pre-surgery fitness level, surgical procedure, and post-operative treatment plan. Even though each patient’s experience can vary, there are common guidelines and recovery markers that each patient can expect following their surgery.

Week 1-3
The first 3 weeks following your surgery are the most critical for healing. Ensuring you maintain good nutritional intake and the use of ice to control inflammation is critical to promote an ideal healing environment. During these first 3 weeks when your body is recovering from surgery, creating and maintaining this optimal healing environment is critical to ensure readiness of the muscles to make necessary strength gains in the coming weeks. Regaining control of the leg muscles (especially the quadriceps) is essential to achieve normal gait (walking pattern) and improve strength for activities like stair climbing and standing from a seated position. Improving mobility of the knee is also necessary to improve function and serves a secondary (but just as important) purpose for healing, helping distribute vital nutrients to the healing tissues.

Week 4-6
This is the period in the post-operative timeline where the remodelling of the tendon replacement (or graft) occurs. When an individual uses their own tendon (a portion of the patellar or hamstring tendon are the most common) as a replacement for the torn ACL, this tendon must undergo a process called remodelling. During remodelling, the tendon will break down (or remodel) into ligamentous tissue suitable to withstand forces required of an ACL. By the end of this stage, most patients will note the greatest improvement in recovery. Provided no other structures were repaired in addition to the ACL, many patients may be able to walk without assistance or a brace, provided their quadricep recruitment has improved sufficiently. Also, if inflammation has decreased sufficiently, they may also gain satisfactory mobility to perform activities like bending the knee to put on pants.

Week 7-12
In this phase, your knee is capable of withstanding greater loads and you may see the greatest gains in functional strength during this period. Generally you will begin working on more activity-specific strengthening and weight bearing exercises, such as squats, ascending and descending stairs, and balancing. You may also be able to begin using stationary bikes with minimal resistance. Your muscles begin to recover their normal function and your gait becomes more normalised. Since the 7-12 week phase involves a lot of repetitive movements and exercises, patience during this phase is critical as you focus on building lower extremity strength, endurance, and control to enable progression to impact exercises in preparation for return to work, sport or other activities during the next phase. It is important that motivation and commitment remain high to ensure success in the next phase.

Month 3-6
During this phase, enough healing has occurred and the ACL has gained sufficient strength to enable you to slowly return to impact activities (running and jumping). You will also typically see greater recovery in muscle control and stability. While your ACL can be subjected to greater forces, you will usually continue to exhibit poor coordinated lower extremity function. Therefore, ensuring the exercises are executed with good form and control is imperative to avoid increased stress to the reconstructed ACL and surrounding tissues. Training the leg to control jumping and landing properly is critical to minimize the risk of re-injury when you returns to sport or other recreational activities. Once sufficient lower extremity control is noted with jumping, hopping and squatting, you can then return to cutting and pivoting activities. Ensuring good form with these activities is essential to full recovery, as rotational motions such as pivoting mimic activities that are common to mechanisms of ACL injury. Often an individual will sustain an ACL tear due to poor leg stability or control during activities such as pivoting and landing from a jump, which is why full recovery in function is essential to minimize the risk for future injury.

Month 7-12
When you can demonstrate good functional strength and stability with squatting, hopping, jumping, running and cutting/pivoting, your physician will clear you to return to activity, such as work or sports. Evidence shows that return to play should be based less on recovery time and more on objective criteria. While the 6 month time frame is typically the earliest most patients are allowed to return to contact sports, graft healing and recovery can take up to 12 months or more. Therefore, you must be mindful to continue monitoring your lower extremity alignment and control during performance of cutting, running and landing to minimize risk of re-injury.

Returning to Sport
The healing process after ACL surgery can be a long one, but the proper rehabilitation can help you get back to the sport you love. Make sure to consult your physiotherapist if you have any questions during your recovery process. At Perth Mobile Physiotherapy, we specialise in treating sporting injuries, including post-operative care, and have successfully rehabilitated dozens of patients after their ACL surgeries. If you would like us to help you with your own ACL rehabilitation, or would like some more information about ACL injuries (such as; do you need surgery, or can you rehabilitate your ACL through physiotherapy alone), feel free to contact us.