ACL Surgery Recovery Timeline

If you’ve recently had a reconstructed ACL, you will most likely be referred to a physical therapist that will implement a rehabilitation program tailored to you and your body. If other parts of your knee were injured such as an mcl and meniscus, there will be slightly different aspects of recovery such as to the time you’re allowed to bear weight. When recovering form a reconstructed acl, there is a platform for which the timeline of your reconstructed acl will be fully recovered. Generally, this acl surgery recovery timeline will take anywhere from 6-9 months of physical therapy. After 9 months, you’re on what could be the most difficult part of your acl recovery – the psychological aspect. It’s an extremely difficult task if your mind isn’t in the right place of thought, but is very common for everyone to experience the “fear of re-injuring your acl” because of how much you go through to get back to playing sports. On top of it, it’s a common statistic for athletes with an acl injury to re-injure the same acl or to even tear their other acl( i’m apart of this statistic). However, if you follow your rehabilitation program and listen to your physical therapist without missing any physical therapy sessions or over-doing your exercises by placing too much stress, you will be fine.

ACL Surgery Recovery Timeline: Phase I-II (0-4 weeks) Your very first meet with your physical therapist will consist of of summarization of what to expect and when you could reach certain milestones such as walking, running, jumping and return to sport. Your physical therapist will remove your compression sleeve and wrap around your knee, which may be the first time you see your reconstructed knee. It will not be a pretty sight to see, but don’t worry, the way it looks swollen, bloody and bruised is completely normal. Your main priorities will be to reduce pain and inflammation, regain knee extension (TKE-Terminal Knee Extension) and restore your normal walking mechanics. Regaining TKE(Terminal Knee Extension) is extremely important in the early timeline of your ACL recovery because even the smallest degree of extension lag will alter your gait patterns. Additionally, if you do not work on regaining knee extension, you can permanently left at the inability to fully extend your knee due to scar tissue build up or may need to go back in for surgery to have your knee manipulated. Slowly wean off your dependence on crutches to begin weight bearing as tolerated.Regain your range of motion(ROM) between 0 to 75 degrees in the first 2 weeks, then up to 110 degrees come the 4th week. Core training will be started immediately with some form of cardio training such as a stationary bike. The stationary bike is a great way to get your blood circulating around your knee to help the recovery process and to increase your range of motion. Simple proprioceptive( balance) training and strength learning activities per protocol based on your physicians requirements. This will help your limb awareness as it lacks this ability, in most cases, well before your injury due to lack of exercising the hip. Exercise examples include: Half-squat, partial lunges, heel raises. Stationary biking.



ACL Surgery Recovery Timeline: Phase III (4-6 weeks) Continue to achieve your goals for reducing swelling, regaining terminal knee extension, range of motion and continued strength building of your legs. A wide range of athletes continue to do a lateral shift with bilateral squats, which is essentially an uneven squat, placing more weight on the uninjured knee. This decreases the athletes confidence with their injured knee 3-4 months after ACL surgery or even when they return to sport. This is a huge risk factor and can be easily prevented with neuromuscular retraining. It’s important to focus on neuromuscular training for all exercises. Ensuring proper kinematics with low level exercises to higher level. Prevention of adduction in the front plane is always emphasized with any exercise. Be aware of your bodies pain and swelling as you exercise as a guide to understand your progress limits. Exercise examples include: single-leg exercises, single-leg squats and climbing stairs. core stabilization and aerobic exercise to increase heart rate. endurance equipment using the stationary bike, stair climber and/or elliptical trainer.



ACL Surgery Recovery Timeline: Phase V (10-12 weeks) Continue to reduce swelling, increase your leg strength and proprioception to prepare for the next phase – running. Work on your limbs ability to endure roughly 2.6x your body weight with the ground forces with running. It’s important to maintain stability in your reconstructed knee’s performance while ensuring adduction is prevented in the front plane. Continue to progress on your plyometric training from low level to higher levels of activity. Increase your proprioceptive retraining with full body exercises and isolated exercises with your injured leg.



ACL Surgery Recovery Timeline: Phase IV ( 6-10 weeks) Continue to reduce swelling, regain full knee extension, knee flexion and strengthening of the muscles around the knee with weigh training and proprioception. Focus on hip proprioception to build a synergistic mechanical flow from your hips, ankles and ankles. It is also key to focus on closed kinetic chain strengthening for your glutes. You will begin doing lateral stepping, step-up and step-down exercises. As you progress, you will begin to increase the resistance with equipment such as an elastic band.



ACL Surgery Recovery Timeline:12-16 weeks Have full knee range of motion. If there is any knee extension restriction of 5 degree or less than 110 degrees flexion, see your physical therapist and surgeon. Your normal gait pattern should be returned( your natural walking mechanics). Continue to progress with building strength in your core and lower body. Exercise examples include: Continue with exercises from previous phases. Single leg press of your own body weight until fully fatigued. Half squats at half your body weight( not past 70 degrees). Increase weight as tolerated. Continue biking. Agility training with balance board, figure 8’s, backward job



ACL Surgery Recovery Timeline: 4-6 months Increase the strength of your quadriceps. Improve your stamina, endurance, coordination and balance. Exercise examples include: Jogging 2 miles or so at about 8 minute a mile stride for 15 minutes daily. Continue to add time every week. Biking should be fully regained with increase resistance. Perform 100+ step-ups/step-downs with reconstructed knee leading each step. Agility training such as figure 8’s, shuttle runs, zig-zags/suicides Activities in your sport you may be able to perform: Shooting drills in basketball. No sharp pivoting drills in tennis. No more than 9-holes in golf to refrain from risk of injury due to fatigue.



ACL Surgery Recovery Timeline: Postoperative Full Rehabilitation (6-9 months)

You must be cleared by your surgeon before you can get back to competing in your sport at 100%

Legs should be the same in circumference as your un-injured knee.

Once you’re fully recovered, you should continue to a similar strengthening program on your at least 2-3x a week. Stationary bike for 10-15 minutes to warm your legs up. Full speed job/run for 20-30 minutes. Agility drills to increase your knees’ proprioception ( shuttle runs, figure 8’s, suicides), single-leg balances on a wobble-board. Running up hills & stairs to build leg strength. Be cautionary with going down hills & stairs as the knee can be irritated and can likely cause a meniscus tear – deceleration, pivoting rotations are the most common reasons for a knee injury.



Conclusion for a Safe Recovery from ACL Surgery:

Take this guideline as a generic guide for when you expect to reach certain milestones for your acl surgery recovery timeline. 6-9 months may seem like an eternity, especially if this is your first time at it – hopefully last. However, take your recovery process day by day because you cannot afford to skimp on your physical therapy. The first month or two will be the hardest because you will either have to wait for a few weeks until you can bear weight depending on your surgery. During this time, the most important things to focus on is regaining full extension, full flexion, decreased swelling and neuromuscular retraining (getting your leg muscles to flex fire again). Once you are able to walk again, it will only get easier because you will see drastic improvements as each day goes by, but do not get overzealous with training. Your mentality should not be to “work harder” but to “work smarter” which means to listen to your body and how it feels. Physical therapy plays a major role in how you recover, but also focus on doing simple exercises to rebuild strength and ROM at least 3x a day at home. On top of that, please eat healthy and do not take any risks by walking too much early on in your recovery. If your knee feels tired, then don’t push it. Usually athletes will be at about 80% and can return to sport. If you do return to sport, do not give it 100%. Just go through the motions to help your legs relearn where it is in time and space (proprioception) because you may only be at 80%. Once you’ve hit the 9 month mark and you’ve done everything correct in your recovery, you will feel like you’re at 200%. At this point, it’s all a MENTAL game, and trust me, you will need to be conscious of your knees, but not to the point of being “worried’ all the time. You will need to be “smart” about your competitiveness. If you’ve played hard for 2 or more hours, your body will be tired and may not hold up as much as you think you can. Continue to be smart and to maintain your everyday exercises. Best wishes in your recovery! =)

Now Read the Next Blog Post: What to Eat After ACL Surgery For a Faster Recovery

Sources:

ACL Prevention: What are stages and areas of concentration within each post op phase?

SportsMedicine.About.com ACL Surgery Rehab

Postoperative Rehabilitation Program for Patellar Tendon Graft

Game Ready: 3 Proven ACL Surgery Recovery Techniques Used by Pro Athletes

ACL Injury Guide. http://www.mayoclinic.com/health/acl-injury/AC99999/PAGE=AC00007. Mayo Foundation for Medical Education and Research (MFMER). Nov. 15, 2007

Santa Monica Orthopaedic and Sports Medicine Research Foundation,ACL Injury Prevention Project. Accessed 10-9-2009.