Stages of Anterior Cruciate Ligament (ACL) Rehabilitation
Generally, following an ACL tear, most individuals will opt for surgery. Recovery from an ACL surgery often takes months of PT in order to restore strength, mobility, stability, and return to sport.¹·² Although each individual’s recovery is different and the timelines may vary, ACL rehab generally falls in 4 stages: Post-op (Early, Intermediate and Late), Strengthening/Plyometrics, Return to Sport, Prevention of re-injury. It is extremely important to have a Physical Therapist guide you through this recovery to make sure you remain healthy. So let’s discuss the goals, exercises and important considerations of each stage. ¹·²
Stage 1 – Post-Op
- Early Post-Op (0-2 weeks)
- Goals:
- Swelling and Pain Management
- Work on Quad Control
- Prevent Infection
- Ankle movement
- Exercises:
- Quad sets
- Passive Range of Motion
- Ankle pumps
- Considerations:
- Assess wound healing
- Weight-bearing: dependent on surgeon’s protocol
- Goals:
- Intermediate Post-Op (3-5 weeks)
- Goals:
- Increase Knee Flexion
- Improve Quad Strength
- Progress Balance
- Exercises:
- Active straight leg raises
- Short-arc quads
- Weight shifting / dynamic balance
- Calf raises
- Considerations:
- Weight bearing without brace
- Goals:
- Late Post-Op (6-8 weeks)
- Goals:
- Full knee flexion & knee extension range of motion
- Progress Quad Strength
- Exercises:
- Stationary bike for ROM
- Squats
- Lunges
- Stairs
- Goals:
Stage 2 – Strengthening / Plyometrics (9-24 weeks)
- Goals:
- Prepare for return to sport
- Work on agility
- Progress endurance
- Exercises:
- Intensive, heavy strengthening through full ROM
- Plyometrics
- Considerations:
- Return to plyometrics/running/jumping protocol should be used by your PT prior to returning to these higher level activities.
Stage 3 – Return to Sport (6+ months)
- Goals:
- Return to Sport
- Build confidence
- The difficulty of trusting your knee prior to an injury drastically differs between individuals
- For athletes that do NOT feel ready, then a PT should help build that confidence with the exercises completed during PT
- Exercises:
- Sport-specific drills
- Continued intensive strengthening / symptom management
- Considerations:
- An athlete MUST clear return to play protocol prior. Without clearing this protocol, an athlete is at higher risk of re-injuring their knee
Stage 4 – Reducing risk of reinjury (12+ months)
- Goals:
- Educate the athlete on exercises to continue after completing PT
- Exercises:
- Unique home-exercise program for an athlete and the demands of their sport.
In conclusion, an ACL Rehabilitation takes months to complete prior to returning to a sport. Even after an athlete returns to their sport, they will need to continue to complete intensive strengthening to keep their knee strong and healthy. Each athlete’s journey back from surgery will be different which is why it is so important to have an experienced PT help you navigate this rehab. If you are having ACL reconstruction surgery, please come visit us at Unbroken Rehab and Athletics and let’s get you back to your sport!
References:
- Jenkins SM, Guzman A, Gardner BB, Bryant SA, Del Sol SR, McGahan P, Chen J. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med. 2022 Jun;15(3):170-179. doi: 10.1007/s12178-022-09752-9. Epub 2022 Apr 6. PMID: 35381974; PMCID: PMC9107547.
- Cavanaugh JT, Powers M. ACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep;10(3):289-296. doi: 10.1007/s12178-017-9426-3. PMID: 28791612; PMCID: PMC5577427.