Recovery from ACL Surgery: Timeline & Tips

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This blog post was originally published on June 24, 2019, and has been updated since then to reflect the latest information. If you’ve recently scheduled ACL surgery to repair a torn anterior cruciate ligament, you’re probably wondering how long it will take before you can get back to your normal routine. While this is certainly an important consideration, ACL surgery recovery involves much more than simply getting back on your feet. Even after you’re able to walk without crutches or other support, your body is still healing, and the recovery process continues. On average, most people take between 2 to 9 months to fully recover from ACL surgery.1 A 2016 study of 80 amateur athletes found that, on average, they were able to return to their sport after about eight months.2 Your doctor will provide personalized recommendations based on your unique circumstances, but the following timeline and rehabilitation tips can help guide you through the recovery process as safely and efficiently as possible. ### ACL Surgery Recovery Timeline While everyone's recovery journey is different, here’s a general outline of what you can expect: #### The First 2 Weeks After Surgery The initial two weeks are a crucial time in the recovery process because your body is particularly vulnerable immediately after surgery. Even though the surgery itself is minor in comparison to other types of procedures, it still represents an injury to your tissues, prompting an inflammatory response. You may experience pain, swelling, and fluid buildup around the knee joint. It’s important to start moving your muscles within a few hours of surgery, even though it may seem counterintuitive. These early movements will be passive, such as gently bending and extending the knee joint. Your doctor will likely advise you not to put weight on your knee yet, and you may need to use crutches or other walking aids for up to two weeks or more.3 Follow your surgeon’s instructions carefully and avoid rushing the process. Re-injury is a real concern, especially at this stage. **Rehabilitation Tips:** - Elevate your leg above the level of your heart and apply therapeutic cold therapy every two hours. - Place your leg over the edge of a bed or chair to encourage knee flexion (bending). - Use a prop under your heel when your knee is straight to promote knee extension (straightening). #### 2-6 Weeks After Surgery During this phase, you may be permitted to gradually put weight on your recovering knee, though activity levels should still remain moderate as your tissues continue to heal. Depending on factors like the type of vehicle you drive, your medication regimen, and which leg was injured, you might also be able to resume driving. At this point, you’ll likely be referred to a physical therapist who will guide you through specific exercises designed to help you regain full range of motion. Since your knee remains vulnerable, you may need to wear a protective brace when not actively exercising to shield it from undue stress.3 **Rehabilitation Tips:** - Perform walking exercises for 15-20 minute intervals. - Do leg-strengthening exercises, like squats, leg presses, and hamstring curls, if your physical therapist recommends them. - Incorporate stationary cycling and/or elliptical training into your routine. #### 6 Weeks to 3 Months After Surgery As the healing progresses, you may be allowed to engage in more low-impact activities. By the three-month mark, you might be able to resume light jogging if your physical therapist approves it. Always consult your healthcare team before starting any new exercise or resuming old routines. Some experts suggest avoiding running or swimming for at least five months post-surgery. **Rehabilitation Tips:** - Perform lateral (side-to-side) exercises, such as lunges and side steps. - Practice flutter-style swimming strokes. - Avoid twisting or pivoting motions. - Continue strength exercises and introduce sport-specific training. #### 3-6 Months After Surgery At this stage, you might feel eager to get back to your sport or daily activities. If you’re returning to a sport, your physical therapist may recommend sport-specific drills to help you prepare. They might also demonstrate exercises you can continue performing even after you've fully healed to help protect your ACL and prevent future injuries. Wear a knee brace if your healthcare provider advises it. **Rehabilitation Tips:** - Gradually reintroduce running activities. - Add jumping and agility drills. - Work toward single-leg plyometric exercises. Assuming your tissues have healed completely, you may be able to return to athletic activities after six months. Some doctors recommend wearing a supportive brace for 1-2 years following ACL surgery. ### Additional Tips for ACL Surgery Recovery Taking an active role in your recovery can help accelerate the process, minimize discomfort, and restore your pre-surgery activity level more quickly. #### Be Patient During Physical Therapy It’s easy to feel impatient, especially for athletes, to push yourself during physical therapy. While it’s essential to complete the recommended strengthening and stretching exercises, doing too much too soon can hinder progress. Follow your physical therapist’s guidance regarding appropriate exercises and intensity levels. If you believe you can do more, always check with your physical therapist first.3 #### Use Cold Therapy to Manage Inflammation Pain and swelling peak in the first week after ACL surgery.1 Applying cold therapy during this time is vital to reduce swelling and alleviate pain naturally. Using active compression along with cold therapy can further decrease swelling by aiding your body in pumping away excess fluid and allowing the cold to penetrate deeper for a longer-lasting effect. The Game Ready System, which combines cold and compression therapies, has been shown to outperform traditional RICE (rest, ice, compression, elevation) methods in reducing pain and edema.5 If you're preparing for ACL surgery, discuss the possibility of using cold and compression therapy with your doctor. ### References:
  1. ACL Surgery Recovery: What to Expect Before and After Reconstruction. UPMC HealthBeat. https://share.upmc.com/2015/04/recovery-time-for-acl-reconstruction-surgery/. Published December 15, 2021.
  2. Notarnicola A, Maccagnano G, Barletta F, et al. Returning to Sport After Anterior Cruciate Ligament Reconstruction in Amateur Sports Men: A Retrospective Study. Muscles, Ligaments and Tendons Journal. 2016. doi:10.11138/mltj/2016.6.4.486.
  3. Recovery & Follow Up. Emory Healthcare. https://www.emoryhealthcare.org/centers-programs/acl-program/recovery/rehab-timeline.html. Accessed Sept. 17, 2024.
  4. After ACL Surgery. UCSF Health. https://www.ucsfhealth.org/education/after-acl-surgery. Accessed Sept. 17, 2024.
  5. Murgier J, Cailliez J, Wargny M et al. Cryotherapy with Dynamic Intermittent Compression Improves Recovery from Revision Total Knee Arthroplasty. J Arthroplasty, 2017;32(9):2788-2791.

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