ACL Reconstruction Rehabilitation: Steps to a successful recovery

Recovering from an ACL (anterior cruciate ligament) reconstruction can be a long and arduous journey. It’s important you have the right support behind you to get you back doing what you love most. With the correct approach, it’s absolutely possible!  In this short blog we will go over the key components of rehabilitation, and what you can expect within each stage of the recovery, so you feel empowered for your journey ahead! 

What is the ACL? 

The ACL is a key ligament that sits within the knee joint. The function of the ACL is to provide stability to the knee joint, especially with rotational movements. You will often see ACL injuries with high-speed movements such as changing direction, landing from a jump awkwardly, or getting bumped into a compromised position whilst playing sport. Once the ACL is ruptured, the knee joint inherently becomes less stable due to having less support. 

Do I need ACL surgery? 

It’s important to mention that not everybody will need an ACL reconstruction, as once commonly believed. There are different management options now, and this can involve: 

• Bracing the knee to facilitate healing (only possible under specific circumstances) 

• Non-operative rehabilitation without bracing 

The decision to undergo surgery depends on things such as your age, goals, knee function post-injury, and other important variables to help guide the decision-making process.  

Regardless, the purpose of this blog is to outline the rehab process from ACL surgery so that you feel more empowered on your journey! 

What does ACL surgery involve? 

Due to having reduced stability with a ruptured ACL, surgery involves replacing the ligament with secondary tissue. There are many different techniques to do this, and this can involve using tendons from other areas of your body, or even tendon tissue from cadavers! The most common techniques involve tendon tissue from other areas of your body, and these are: 

• The hamstring tendon 

• The patella tendon 

• The quadriceps tendon 

  
  

The graft choice will come back to a shared decision-making process with your surgeon. This is usually dependent on your injury history, anatomy, gender, and surgeon preference/expertise. Regardless, the rehab process follows a very similar trajectory, with slight modifications to exercise focus and progression.  

Phase 1: Early Post-operation (Week 0 – 4) 

This is by far the hardest part of rehab (Trust me, I’ve been through it twice!). You’ve just come out of surgery; the knee is swollen and probably a bit sore. Walking can feel like a massive effort, and just doing normal daily tasks require a lot of focus. But don’t stress because with professional support behind you, we can get through this phase seemingly! 

Rehab Phase Goals:  

• Pain management 

• Reducing swelling 

• Restoring knee range of motion 

• Good muscular activation 

• Walking retraining  

Treatment will involve a combination of range of motion exercise, hands on techniques such as massage, and swelling management techniques such as compression, elevation, and pool exercise. A focus on local muscle activation for the quads, hamstrings, calves and glutes is also important, as the swelling from the surgery can negatively impact muscle recruitment. As the knee starts to settle and your function improves, we can start to progress your exercise into more functional and demanding movement patterns.   

Phase 2: Restoring Function (Months 1 – 4) 

This is where we start to progress your exercise rehab in the gym, loading the quads, glutes, hamstrings, and calves in the gym. Rehab goals progress from calming the knee down to improving its capacity. There is a specific focus on movements such as squats, lunges, and hip hinging patterns such as deadlifts and hip thrusts. Other areas of focus include balance work, running technique drilling (if relevant), and low intensity plyometrics to improve our confidence and coordination with more complex movement patterns.  

All of this lays the groundwork for a solid foundation to prepare for the more demanding tasks of Phase 3. 

Phase 3: Maximising Capacity (Months 4 – 9) 

Now that we’ve established a good foundational capacity, the focus for this next phase is to maximise your strength capacity, return to more complex tasks such as running, and gradually increase the intensity of these tasks to improve confidence.  

There is still a large focus on gym rehab to gain as many strength improvements as possible. At the same time, you’ll be progressing your plyometrics to advanced techniques, as well as a gradual exposure to change of direction running to challenge the dynamic stability of the knee. If the goal is to return to sport, we’ll start to replicate the key movement patterns and skills which underpin sports performance, but this will all be in more controlled environments.  

Phase 4: Return to Sport/Activity (Months 9 –12) 

By this stage of your rehab, you’ll have achieved a solid block of running, gym strengthening, plyometrics, and sport-specific training. The next step is to piece this all together and transfer it to more challenging and chaotic environments. This can involve a return to team training which specific restrictions and individual drills, and then gradually removing restrictions and blending into full unrestricted training.  

Whilst doing this, we’re making sure we maintain our strength improvements from the past few months and maxismising plyometric power to feel confident in returning to sport. You will undergo a battery of performance testing to assess readiness to return to full sport, and this will coincide with your return to training process. This phase isn’t about restoring, it’s about performing! 

Final Thoughts 

It’s important to note that the time taken to return to unrestricted sport will vary between person to person. This will depend on factors such as your age, sporting level, previous injury history, and rehab progress. However, it can take 9-12 months to make a full recovery for most people.  The journey to a full recovery is challenging but achievable. With the right rehabilitation plan, you can make a successful return stronger than before getting injured!