If you need surgery to repair an anterior cruciate ligament (ACL) tear, you’re likely wondering about the post-surgery recovery process. At Interventional Spine & Surgery Group, our multidisciplinary team provides fast access to orthopedic care, including ACL tear reconstruction surgery, near you in central and northern New Jersey. We want to help patients have peace of mind before their procedure, so we’ve outlined a week-by-week recovery guide to help them understand what to expect during the process. Learn more about ACL reconstruction recovery and what you should know about each phase.
Key Takeaways
- An anterior cruciate ligament (ACL) tear is a common orthopedic injury that can be treated with non-surgical methods or a surgical procedure called ACL reconstruction.
- After a patient gets ACL reconstruction, they will go through five distinct phases of recovery that each has different milestones and goals.
- Phase 1 occurs immediately after the procedure, Phase 2 starts early rehabilitation, Phase 3 concentrates on strengthening and balance, Phase 4 focuses on sport- or activity-specific training, and Phase 5 works toward a full return to sports or activities.
- Complications to be aware of after ACL reconstruction include signs of an infection or blood clot, ongoing stiffness or feelings of instability, and a failed graft.
- Interventional Spine & Surgery Group provides comprehensive orthopedic care, including ACL tear reconstruction surgery, for patients in central and northern New Jersey.
What Is an ACL Tear, and How Is It Treated?
The anterior cruciate ligament (ACL) is one of the four main ligaments in the knee that helps provide stability and connect the femur (thigh bone) to the tibia (shin bone). It is designed to prevent the shin bone from sliding too far forward, especially during sudden twisting or pivoting. However, when the ACL is forced beyond its limits, it can become damaged. This is known as an ACL tear, which can result in deep pain in the center of the knee, rapid swelling, instability, and a reduced range of motion.
Treatment for an ACL tear spans from non-surgical treatments, such as physical therapy and bracing, for milder injuries to surgery for more severe tears. Surgery is most often considered when the patient is young and active, plays sports that involve pivoting and cutting motions, or has significant knee instability. Known as an ACL reconstruction, this surgery replaces the torn tissue with a tissue graft from the patient’s body or a donor. The surgery, although often effective, has a long recovery timeline that patients should be aware of.
The Five Phases of ACL Recovery
After a patient receives ACL surgery, they will begin a progressive rehabilitation process that is made up of several different phases. The timeline for recovery typically ranges from nine to 12 months.
Phase Recovery Table
| Phase | Weeks/Months | Goals | Activities |
|---|---|---|---|
| Phase 1 |
1 to 2 weeks |
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| Phase 2 |
3 to 6 weeks |
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| Phase 3 |
7 to 12 weeks |
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| Phase 4 |
3 to 6 months |
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| Phase 5 |
6 to 12 months |
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Week 1-2: Immediately After Surgery
Immediately after the procedure, the first phase begins. It lasts for the first two weeks post-op, and focuses on protecting the new graft, regaining basic muscle control and full knee extension, and managing pain and swelling. The patient will be instructed to wear a knee brace and use crutches for seven to 10 days to keep the joint stabilized and prevent weight-bearing.
Under the guidance of a physical therapist, the patient will begin gentle physical therapy exercises, such as straight leg raises and small knee bends. These help to prevent stiffness and improve range of motion without overly stressing the joint.
Weeks 3-6: Early Rehabilitation
The next phase in ACL surgery recovery spans from weeks three to six. It prioritizes:
- Building early leg strength
- Restoring normal walking ability (with proper posture and without a limp)
- Improving the knee bend (at least 90 degrees)
- Reducing remaining swelling
Patients will slowly transition off crutches to put partial weight on the affected leg. They will also start exercises that help with quad activation, full knee extension, and full knee bending. Other exercises will work the thighs and hamstring muscles to build them without straining the knee. Some examples of exercises in this phase include straight leg raises, mini-squats, weight shifts, and standing calf raises. Balance training, stationary bike rides, and treadmill or elliptical use may also be incorporated.
Weeks 7-12: Strengthening Phase
The next phase spans from weeks seven to 12. It focuses on strengthening the leg overall, improving balance, and introducing light impact movements to prepare the leg for gentle running or agility training. To do so, physical therapy often includes:
- Resistance exercises: Using resistance bands or light weights, these exercises help strengthen muscles around the knee, such as the quads, hamstrings, and glutes. Exercises include heavy single-leg presses, squats, hamstring curls, and calf raises.
- Single-leg exercises: To improve coordination and stability, single-leg exercises like single-leg stands and balance training are used.
- Low-impact cardio: To boost cardiovascular endurance and knee flexion, controlled, low-impact cardio like light jogging, stationary biking, or using an elliptical is often utilized.
Aside from enhancing strength and preparing for low-impact cardio, this phase is also focused on improving the patient’s confidence in their knee and its restored abilities.
Months 3-6: Functional Training
The next phase in ACL tear recovery focuses on functional or sport-specific training. It encompasses months three to six, with goals like achieving exercise without pain or swelling, fully moving the knee (bending and straightening), and safely preparing the knee for high-impact movements. Techniques used in this phase include:
- Beginning a walking-to-jogging progression on flat surfaces
- Building strength with heavier, lower-repetition leg exercises, such as split squats, single-leg deadlifts, and more
- Introducing light plyometrics and agility work, such as low-impact jumping, cutting, and landing drills
By gradually incorporating sport-specific movements into the recovery process, the patient learns how to perform important movements without affecting their healing ligament or increasing the chance of re-injury.
Months 6-12: Return to Sport
The final phase of recovery after ACL surgery lasts anywhere from six months to 12 months after the procedure. It helps ensure a safe return to sports by helping patients bridge the gap between strength and agility in the gym and high-impact sports movements. It also focuses on maintaining lasting knee strength and preventing future injuries.
During phase 5, the main areas include:
Agility Training
Agility training helps the patient work on controlling their body, especially when decelerating or changing directions rapidly. It is crucial for patients who are looking to return to sports like soccer, football, and hockey. This training involves start-stop drills, reaction drills, and more.
Plyometrics
Plyometrics concentrates on developing explosive power and vertical force, which is often used in high-impact sports. Using specialized jumping routines and related exercises, the patient can work on proper jumping and landing mechanics.
Return-to-Sports Testing
Before a patient can be cleared to return to sports fully, they need to undergo specialized return-to-sport (RTS) testing. It typically features a few assessments, which help determine if the patient is ready both physically and psychologically to return to competitive sports. They include:
- Strength testing, targeting 90% to 95% strength symmetry between limbs
- Hop testing, which includes single-leg hops and triple hops, to evaluate explosive power and landing stability
- Agility and movement quality to check multi-directional control and deceleration abilities
- Psychological readiness tests, which assess the athlete’s fear of re-injury and confidence
If the patient achieves a Limb Symmetry Index (LSI) of 90% or greater compared to the uninjured side, they will typically be approved to return to sports. Their doctor will provide final medical clearance before they can participate.
What Are Some Complications to Watch for After ACL Surgery?
After ACL reconstruction and during the recovery process, there are a few potential complications you should be aware of, including:
Post-Surgery
Right after you get the procedure done, there are some side effects that may occur that you should keep an eye out for. They include:
- Infection: Be aware of signs of an infection, such as fever, chills, increased redness, or pus draining from your incision.
- Numbness: If you have a loss of feeling near the incisions on your leg, you may have tiny nerves that got disrupted during the cutting of the skin. It typically subsides, though small areas may stay numb.
- Blood clots: Symptoms like pain, swelling, or redness in your calf can signal a blood clot, which requires immediate medical attention.
Ask your surgeon about these side effects or seek prompt medical attention if you have any signs of a blood clot or infection.
During Recovery
Once you’re deeper into the recovery process, there are some additional complications to be aware of. They include stiffness and loss of motion, which can be due to scar tissue buildup, or recurring feelings of instability, which may be due to the graft tearing or not healing right. If the graft isn’t healing properly, you may need revision surgery or specialized physical therapy. Ask your surgeon or physical therapist about these complications.
Find Expert ACL Tear Treatment Near You in New Jersey
If you’re preparing for ACL reconstruction and recovery, it’s helpful to know what to expect. When you get treated at Interventional Spine & Surgery Group, your procedure will be performed by Dr. Deramo, a board-certified orthopedic surgeon. He uses minimally invasive methods whenever possible to help patients recover faster. At Interventional Spine & Surgery Group, we can see you now, we care, and we’ll help you get better. To learn more about ACL tear recovery or to schedule an appointment near you in central or northern New Jersey, contact us today.
Frequently Asked Questions About ACL Tear Recovery
How long does ACL tear recovery take?
Full recovery after an ACL tear typically takes six to 12 months, especially to return to high-impact sports. However, daily activities and light movement resume much sooner, often around six to 12 weeks post-op.
When can I walk after ACL surgery?
Patients can typically walk with a brace and crutches a few days after surgery. However, to put full weight on the foot, it takes around two to three weeks. To walk completely without crutches, it typically takes four to six weeks.
When can I drive after ACL surgery?
When you can drive after ACL surgery depends on which leg is affected and your specific recovery progress. However, many patients can drive within four to six weeks after surgery.
What are the phases of ACL rehabilitation?
The five phases of ACL rehabilitation include:
- Phase 1: This occurs immediately after the procedure and lasts until two weeks post-op.
- Phase 2: This phase begins early rehabilitation and lasts from weeks three to six.
- Phase 3: This phase focuses on strengthening and balance, and it lasts from weeks seven to 12.
- Phase 4: This phase concentrates on sport-specific training, lasting from months three to six.
- Phase 5: This phase focuses on a full return to sports and medical clearance, which spans from months six to 12.
When can I return to sports after ACL surgery?
You can often return to sports within nine to 12 months of your surgery. However, full recovery and a return to sports require passing functional tests.
What should I avoid during ACL recovery?
During ACL recovery, you should avoid:
- Twisting or pivoting motions
- Participating in high-impact sports too soon
- Skipping physical therapy
What are signs of ACL graft failure?
Signs of an ACL graft failure include knee instability, persistent pain, recurrent swelling, joint stiffness, and a reduced range of motion.
How many PT sessions are needed after ACL surgery?
There isn’t a set number of physical therapy sessions that are required after ACL surgery. However, most patients require at least 20 to 40 PT sessions spanning nine to 12 months.