From Surgery to Sports: ACL Reconstruction Recovery Explained

Anterior cruciate ligament (ACL) injuries are common in athletes, particularly in sports that involve jumping, twisting, and rapid changes in direction. These include football, basketball, skiing, and soccer.

An ACL rupture (complete tear) is often treated with reconstruction surgery, in which the torn ligament is rebuilt with new tissue. This can also offer a lifeline when nonsurgical treatment fails, allowing people to return to their favorite sports and activities. In this article, we’ll explore what ACL reconstruction is, the phases of recovery, and red flags that could be a sign of surgery complications.

What is ACL reconstruction?

Managing an ACL tear can be painful and frustrating, particularly when it stops you from keeping active and playing sports. After an ACL partial tear, many people make a return to full fitness without surgery, however, nonsurgical treatment is unsuccessful in 17.5% of people according to research.

People who don’t recover without surgery are often offered an ACL reconstruction. This procedure involves replacing your torn ACL with new tissue taken from your own body or a donor. Tissue from your own body is often taken from the kneecap tendon, quadriceps tendon, or hamstring tendon.

Here, we’ll run through the recovery process in detail, from the day you have surgery to the day you return to sports.

Phase 1: immediate post-surgery recovery (0–2 weeks)

Most ACL reconstruction surgeries are performed as a day case, meaning you can go home the same day as your operation. A physical therapist will show you how to walk with crutches and the medical team will check if you’re safe to leave the hospital.

You’ll be shown how to manage pain with ice, painkillers for knee pain, and elevating your operated leg. People are often curious about CBD for knee pain, but unfortunately, despite promising effects on nonsurgical joint soreness, it does not appear to have any effect on post-surgical knee pain.

You’ll be given some gentle bed stretches and exercises to do, but the first two weeks are mainly about rest and pain management. You will usually wear a brace that locks your knee straight for at least two weeks.

Phase 2: early rehabilitation (2–6 weeks)

Your first physical therapy appointment will likely be around two weeks post-op. A structured rehabilitation program including strength training, mobility, balance, and flexibility exercises will improve your knee’s function after ACL surgery.

Your initial physical therapy exercise will be gentle. These recovery exercises focus on regaining full movement in the knee, building confidence walking without crutches, and starting to build strength without putting pressure on the site of your surgery.

Your physical therapist may unlock your knee brace to allow more movement, depending on your surgeon’s instructions and how strong your knee is. You will be tested during sessions (usually every week or two) and given an exercise program to complete at home.

Phase 3: developing strength and flexibility (6 weeks–3 months)

Many people can stop wearing their knee brace after six weeks. However, you may need to wear it longer if you have also had your knee cartilage repaired, or if your knee is weaker than it should be.

You will be given more challenging exercises to get your knee strong and flexible, which may include squats, lunges, leg presses, and balance board exercises. You can gradually return to most of your daily activities.

Your physical therapist will help you understand your symptoms and what they mean. In general, if your knee swells or becomes more painful, you have pushed it too hard and need to take it easy for a day or two.

Phase 4: full recovery and return to sports (3–12 months)

If you wish to return to sport, you will work on this for the next three to 12 months with your physical therapist. Research shows professional athletes can sometimes return to sport as early as three months post-surgery.

However, caution should be taken because early return to sport has been linked to failed ACL surgery. Some sports pose a higher risk for ACL reinjury than others — your surgeon and physical therapist will advise on the recovery timeline for your specific sport. Maximum improvement after ACL reconstruction surgery is reached by one year.

There will be specific criteria to meet before you can return to sport, advised by your surgeon and physical therapist to encourage healing and prevent further injury. These milestones often include:

• Achieving full range of motion
• Completing a hopping test with similar results to your uninjured leg
• Passing balance tests
• Achieving strength comparable to your unoperated leg

You will complete sport-specific exercises and drills, possibly taking part in rehabilitation games with other athletes at a similar point in their recovery. Unfortunately, up to 30% of athletes experience a second ACL injury after their initial one. To prevent future knee injuries, your physical therapist will teach you long-term strategies, such as:

• Ongoing strengthening programs
• Using a knee brace if required during sport
• The best way to perform certain movements to avoid injury
• Warm-up and cool-down routines

Bad signs after ACL surgery

After ACL surgery, certain symptoms can indicate a problem with your operated knee. For example:

• Knee instability or difficulty taking weight through your leg may indicate a failed graft or non-healing.
• A very stiff knee could be a sign of excessive scar tissue around the joint, a fibrous nodule on the ACL (cyclops syndrome), or insufficient rehabilitation.
• Popping in the knee or suddenly giving way may signify a re-tear of the ACL or other structural problems.
• Pain, sudden difficulty walking, and a very swollen calf can indicate a blood clot in the leg, while chest pain and difficulty breathing may indicate a blood clot in the lungs.

Committing to your rehabilitation program will have a big impact on the outcome of your ACL surgery. It’s a journey that can be challenging at times, requiring dedication and patience. Your medical team will guide you through the process, helping you pave the way for a successful return to your favorite sports and activities.