Rehabilitation after Anterior Cruciate Ligament Reconstruction

Rehabilitation after Anterior Cruciate Ligament Reconstruction

Your Road to Full Recovery

Rehabilitation is a vital part of your journey following anterior cruciate ligament (ACL) reconstruction. Using a tendon graft, your surgeon has reconstructed the ligament by securing the graft in bone tunnels created in the tibia and femur. While it takes 2-3 months for the graft to integrate with the bone and at least 3 months for blood supply to fully re-establish, the graft is strong enough during this time to support a structured, supervised rehabilitation program.

Here’s what to expect as you progress through your recovery milestones:

In-Patient Recovery

You will be discharged on the same day as your surgery or after an overnight stay. Before leaving, you will have:

  • Gained initial control of your knee.
  • Begun gentle bending of the joint.

Week 1: Building the Foundation

By the end of the first week, you should aim to:

  • Straighten your knee fully and bend it to 90 degrees.
  • Independently lift and control your leg.
  • Walk with crutches, bearing partial or full weight.
  • Start basic hamstring and quadriceps exercises as demonstrated by your physiotherapist.

Most patients can transition to walking without crutches within 7 days, depending on comfort and stability.

Month 1: Restoring Mobility and Strength

Outpatient physiotherapy will guide you through this phase with these goals:

  • Achieve full knee straightening within two weeks.
  • Regain near-normal knee bending by the end of the month.
  • Begin strengthening muscles with co-contraction and closed-chain exercises.

By the end of the first month, you should:

  • Be walking comfortably outdoors.
  • Return to work and driving.

Month 2: Strengthening and Progression

This phase focuses on advanced muscle strengthening, particularly the hamstrings, which play a key role in knee stability. Goals include:

  • Normal knee bending.
  • Increased intensity of closed-chain exercises.
  • Regular use of an exercise bike.

Kneeling may still be uncomfortable during this phase but should improve with time.

Month 3: Proprioception and Neuromuscular Control

Your physiotherapist will focus on restoring your body’s awareness of joint positioning and neuromuscular control. Key activities include:

  • Proprioceptive exercises to enhance balance and coordination.
  • Gradual introduction of gym equipment, avoiding open-chain exercises.
  • Regular cycling to build endurance.

Month 4: Strength, Power, and Jogging

The emphasis shifts to rebuilding muscle strength and power. Activities include:

  • Straight-line jogging, preferably on grass or soft surfaces.
  • Avoiding gradients, sharp direction changes, and jumping unless supervised.
  • Progressing proprioceptive exercises with agility and plyometric training.

Month 5: Agility and Fitness Recovery

This phase prepares you for more complex movements:

  • Perform advanced agility and plyometric drills.
  • Engage in a Prevent Injury and Enhance Performance (PEP) program.
  • Restore muscle bulk, power, and fitness to near-normal levels.

Month 6 and Beyond: Return to Sport

Rehabilitation now focuses on sport-specific drills to rebuild confidence, agility, and performance. Goals include:

  • Full fitness and readiness for competitive sports.
  • Progressive return to ball sports, jumping, and directional changes.

Return to Competitive Sports

Returning to high-impact or competitive sports requires 9-12 months of dedicated rehabilitation, depending on your progress and activity level. For activities involving jumping, quick direction changes, or contact, you must complete a tailored return-to-sports program under expert guidance to minimize the risk of re-injury.

Achieve your recovery goals with our expert-led rehabilitation program designed to restore your strength, stability, and confidence.

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