Physiotherapy After Anterior Cruciate Ligament (ACL) surgery: Optimize your rehab (Updated 2023)

Anterior cruciate ligament tears are common in sports that require pivoting and jumping, such as rugby, football and basketball. Although, some people can make a satisfactory recovery with conservative treatment alone, a large number of patients require surgical intervention to repair their ACL. The goal of this blog post is to educate patients on how to optimize recovery and prevent relapses following an ACL reconstruction.

Phase 1 (0 to 2 weeks)

The day after the surgery you can start walking using some crutches. You are allowed to weight bear as much as you can. However, If your meniscus was repaired too during the operation, your surgeon might order you to avoid weight bearing during the first 6 weeks. A physiotherapist will teach you some exercises to improve your knee range of motion, and start activating your quadriceps muscle. The goal should be to achieve 0-90 degrees range of motion, and be able to lift your leg straight from lying position within the first two weeks post operation. If a hamstring graft was used to repair your ACL, you might have pain, tightness and bruising in the posterior part of your thigh. Your physiotherapist can help you release the tightness by applying some soft tissue massage.

Phase 2 (2 to 6 weeks)

After two weeks, you should be able to walk without crutches for short distances. You can gradually start doing bodyweight strengthening exercises such as squats and lunges, and progress to weighted exercises over a period of 4 weeks. You should also be able to flex your knee to 120 degrees after 6 weeks post operation.

Phase 3 (6 to 12 weeks)

The emphasis during this phase is to build up strength in the quadriceps muscle. The leg extension exercise can be started after 6 weeks, initially with partial range of motion between 90 and 30 degrees, and gradually progressed to 90 to 0 degrees. By the end of the 12 week period, you should have regained 90% of quadriceps strength compared to the unaffected leg, and full range of motion.

Phase 4 (3 to 6 months)

If you have satisfactory range of motion and strength, you will be able to start jogging at 12 weeks post operation. During this period, you will need to continue progress your lower limb strength. You will also be instructed to do some balance training in order to improve your control and coordination.

Phase 5 (6 to 9 months)

The final stage of your ACL rehab consists of practicing advanced agility drills to mimic the requirements needed for your sport. Besides improving your physical capabilities, these exercises will also help you improve your confidence and eliminate the fear of reinjuring your knee.

Conclusion

Remember, the rehab phases outlined above are only some general guidelines. Don't feel discouraged if you are not progressing as fast as you would like, since many factors can affect your recovery time. If you have any doubt about your rehabilitation program, always consult your doctor or physiotherapist to get a clarification.

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