Clinically reviewed by What is acl surgery recovery
An ACL reconstruction does not repair the torn ligament. The surgeon builds a new one, usually from your own hamstring or kneecap tendon, and fixes it inside the knee.
The graft is at its most securely fixed on the day of surgery. Over the following months the body converts it into living ligament, and for part of that process it is weaker than at the start. That is why this rehabilitation takes months.
So a knee that feels strong and painless at four months is not ready for football or cricket. Feeling ready and being ready are different, and the gap between them is where most re-tears happen.
Symptoms you might have
- Swelling for the first few weeks, and some returning after harder sessions for months
- Difficulty straightening the knee fully in the first days, which has to be fixed early
- A thigh muscle that will not switch on, which is normal and the first job of rehabilitation
- Numbness in a patch of skin below or beside the scar
- Pain where the graft was taken from, often more noticeable than the knee itself
Why it happens
- Returning to pivoting sport too early, the commonest cause of a failed graft by far
- Going back on how the knee feels rather than on strength and hop testing
- A thigh muscle that was never brought back to match the other leg
- Skipping the landing, cutting and deceleration work and going straight into matches
- Poor hip and trunk control, which lets the knee collapse inwards on landing
- Stopping rehabilitation at three months because the pain has gone
When you should see a physiotherapist
Your surgeon's protocol governs this rehabilitation. Which graft was used, whether a meniscus was repaired too, how much weight the leg may take, whether a brace is worn and when running may start are all set by them. A meniscal repair makes the early restrictions much tighter.
Start as soon as your surgeon allows, usually within the first week. If surgery has not happened yet, rehabilitation beforehand is worth doing: a knee that enters theatre straight, with a working thigh muscle, recovers better.
Contact your surgeon the same day for a hot, red, swollen or leaking wound, or a fever. Go to hospital for a hot, swollen, painful calf with or without breathlessness, or for sudden chest pain or breathlessness. Tell your surgeon if the knee locks, will not straighten, or gives way with a pop and sudden swelling.
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How it is treated
This is a staged programme. Each stage is passed rather than waited out, and your surgeon's protocol sets the limits.
- Weeks nought to two. Settle swelling with cryotherapy, compression and elevation, get the knee fully straight, switch the thigh muscle on, walk safely with crutches and any brace prescribed
- Weeks two to six. Full straightening maintained, bending progressed, walking without crutches, basic strength and balance work started
- Weeks six to twelve. Exercise therapy becomes the main work: cycling, leg press, step work, single leg control, hip and trunk strength
- Three to six months. Heavier strengthening, hopping and landing technique, straight line jogging once your surgeon and the strength testing agree
- Six to nine months. Change of direction, cutting, sport specific drills and non contact training
- Nine months onwards. Matches, once strength and hop tests are close to the other leg and your surgeon has cleared you
Manual therapy for kneecap mobility, TENS for early pain on intact skin away from the wound, and gait retraining support the programme. Ultrasound, needling and cupping are not used over the healing wound or the graft site.
Exercises, and what to avoid
What helps
- Static quadriceps and straight leg raises from the first days, until the thigh muscle fires reliably
- Heel props, and lying face down with the knee off the edge, to get the knee fully straight
- Single leg balance and control work, progressed through the middle months
- Hopping and landing drills later on, taught slowly, because how you land is what protects the graft
What to avoid
- Twisting, pivoting and side stepping until your programme reaches that stage
- Deep squatting, lunging and kneeling early, particularly with a kneecap tendon graft
- Any exercise your surgeon's protocol restricts. Open chain knee extension is commonly limited early
- Testing the knee out in a game to see how it feels. That is how grafts tear
What you can do at home
Ice and elevate in the first weeks. Fifteen to twenty minutes with the leg propped above the hip, several times a day, a cloth between pack and skin, nothing on the wound. Heat is not useful while the knee is swollen.
Get the knee straight before you worry about bending it. Sitting with the heel propped and the knee unsupported for ten minutes, several times a day, does more than any stretch.
Do the exercises every day. This programme is won at home. Sessions are for checking, correcting and progressing.
Expect some swelling the day after a harder session. Swelling still there two days later means it was too much.
How long it takes
Crutches are usually needed for one to two weeks, longer if a meniscus was repaired. Walking normally returns around three to six weeks, and driving commonly at four to six, on your surgeon's say.
Straight line jogging typically begins between three and four months, and only when thigh strength and the knee's response allow it.
Return to pivoting sport such as football, cricket or badminton is usually nine to twelve months. The evidence is consistent that going back earlier than about nine months, or without strength and hop testing close to the other leg, raises the risk of tearing the graft or injuring the other knee.
It is slower with a meniscal repair and when the thigh muscle is slow to return, and faster when no stage is skipped.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
اے سی ایل کے آپریشن میں پرانی لیگامنٹ جوڑی نہیں جاتی، نئی بنائی جاتی ہے۔ یہ نئی لیگامنٹ کئی مہینے تک تبدیل ہوتی رہتی ہے اور اس دوران کمزور بھی ہوتی ہے۔
اسی لیے یہ علاج ہفتوں کا نہیں، مہینوں کا ہے۔ چوتھے مہینے میں گھٹنا ٹھیک لگتا ہے لیکن کھیلنے کے لیے تیار نہیں ہوتا۔
شروع میں سب سے اہم کام گھٹنے کو پورا سیدھا کرنا اور ران کا گوشت چالو کرنا ہے۔ سوجن کے لیے ٹھنڈی پٹی اور پیر اونچا رکھنا۔
دوڑنا عام طور پر تین سے چار مہینے بعد شروع ہوتا ہے۔ کھیل نو سے بارہ مہینے بعد، جب طاقت دوسری ٹانگ کے برابر ہو اور سرجن اجازت دے۔ وقت سے پہلے کھیلنا ہی لیگامنٹ دوبارہ ٹوٹنے کی سب سے بڑی وجہ ہے۔
Roman Urdu
ACL ke operation mein purani ligament jori nahi jati, nayi banai jati hai. Ye nayi ligament kai mahine tak tabdeel hoti rehti hai aur is dauran kamzor bhi hoti hai.
Isi liye ye ilaj hafton ka nahi, mahinon ka hai. Chauthe mahine mein ghutna theek lagta hai lekin khelne ke liye tayar nahi hota.
Shuru mein sab se ahem kaam ghutne ko poora seedha karna aur raan ka gosht chalu karna hai. Sujan ke liye thandi patti aur pair ooncha rakhna.
Daurna aam tor par teen se chaar mahine baad shuru hota hai. Khel nau se barah mahine baad, jab taqat doosri taang ke barabar ho aur surgeon ijazat de. Waqt se pehle khelna hi ligament dobara tootne ki sab se bari wajah hai.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
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Use the consultation to discuss which care and exercises fit your situation.
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Questions people ask
How long does ACL recovery take?
When can I start running after ACL surgery?
Why can I not play if my knee feels fine?
Do I need a knee brace after ACL reconstruction?
Does taking the graft from my hamstring weaken my leg?
Related conditions
- Rehabilitation after a fracture
- Recovery after knee replacement
- Recovery after hip replacement
- Physiotherapy after surgery
- Sports injury treatment