So, you ruptured your ACL and had it surgically repaired. You are probably feeling nervous about your recovery and you might be unsure what to expect. What now? What’s the first step on the road to returning to your sport or active life? Your doctor will likely direct you to physical therapy to help you regain motion, strength, and function of your knee. At SetPT, we’ve helped countless people go from crutches to returning to sport.

One of the most important factors to consider in post-operative ACL management is the surgical procedure and specifics. Your rehab will vary depending upon whether you also had a meniscus repair or another ligament repaired, such as the MCL, LCL, or PCL. Furthermore, the type of graft used, whether a cadaver ACL, part of your hamstring, or part of your patellar tendon, should be considered. Your surgeon may provide you with a detailed protocol depending upon the damage sustained and structures repaired.

Rehabilitation after an ACL repair is a long, but well-developed process. Many doctors have their own specific protocol for their expectations and goals, which they will provide you prior to starting physical therapy. Generally, the protocol is divided into five phases, structured after the weeks that follow the surgery:

Phase I: 0-2 weeks, immediate post-operative

    1. a. Focused on pain management, reducing swelling
    2. b. Initial range of motion in flexion and extension
      1. c. Initiate quadriceps activation

Phase II: weeks 2-4

    1. a. Reduce residual swelling
    2. b. Focus on full passive range of motion
    3. c. Initiate and progress quadriceps and hamstring strengthening

Phase III: weeks 4-12

    1. a. Full range of motion
    2. b. Progress strengthening of all leg muscles
    3. c. Initiate and progress balance training

Phase IV: month 3-6

    1. a. If previous goals met and cleared by PT and doctor, plyometrics and more complex dynamic strengthening may be initiated and progressed

Phase V: month 6+, return to sport

    1. a. Focus on sport specific motions and activities

Again, many doctors have their own specific protocols that will outline their plan for your progress. Post-operative ACL rehabilitation is a constant process of re-evaluation. Your protocol may vary and change depending on your progress. If you are scheduled for an ACL reconstruction, it is a good idea to consult with a physical therapist prior to your surgery to establish your goals, learn some pre and post-operative exercises, and familiarize yourself with the rehab process.