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ACL Surgery Recovery

Timeline of ACL Surgery Recovery and Exercises That Help the Most

Recovery from an ACL surgery is a gradual process. ACL refers to anterior cruciate ligament, located just below the knee. An injury to this ligament may require a reconstruction surgery. The following write-up provides information about the rehabilitation process, before and after the surgery.
Medha Godbole
Last Updated: Feb 28, 2018
Rehabilitation post an ACL surgery is a lengthy and time-consuming process. The knee surgery which is also known as ACL reconstruction, is done by replacing the injured anterior cruciate ligament located in the knee with grafts, such as the autograft or allografts. The reconstruction can be done through arthroscopic surgery or an open surgery.
ACL refers to one or two ligaments that stretch across the middle of the knee, connecting the femur to the tibia. It prevents the femur from sliding backwards to the tibia, and also stabilizes the knee when attempts are made to stop and turn quickly. ACL injuries are often caused due to sports and other fitness activities. Players who are engaged in sports like football, basketball and soccer, in which sudden direction changes are needed, are prone to getting these injuries. After the ACL arthroscopic surgery, a person usually does not spend the night in the hospital. The recovery for the surgery which includes physical rehabilitation can take several months, maybe even a year. The entire recovery period is divided into a four phases, which is preceded by a preoperative phase.
ACL Surgery Recovery Timeline
Preoperative Phase
The preoperative stage begins right after an ACL injury. The goals in this phase include reducing the swelling, returning full range of motion and appropriate strength to the knees. The swelling is controlled with ice packs or cold compression cuffs, also known as Cryo/Cuff. The injured knee should be immobilized by using crutches and knee immobilizer. Non-steroidal anti-inflammatory medications such as Advil, Motrin and Ibuprofen can help in controlling the swelling and pain post the injury.
ACL Injury Recovery Exercises
The physiotherapist tries to restore the normal range of motion with a range of exercises that include heel props, prone leg hangs and heel slides.
Heel Props
passive knee
Remove the knee brace after every two to three hours when awake. Place the heel on a rolled towel or a pillow, so that the thigh and the calf is off the table. Let the knee relax into this extension for ten to fifteen minutes. This exercise has to be done three to four times in a day, after an ACL injury.

The knee prop exercise can also be done while sitting on a chair. Support the heels on another stool or a chair, and allow the unsupported knee to sag into passive extension.
Prone Leg Hangs
Prone Leg Hangs
This exercise is done to regain full range of extension during the preoperative stage. Lie on the stomach with both legs hanging straight off the edge of the bed. Relax and allow the leg to hang for around two minutes.
This exercise can also be done by lying on the stomach with a pillow under the affected knee, thus allowing the leg to hang freely. This is a good recovery exercise as it helps in straightening the knees. In the later stages of recovery, a weight can be placed over the heel to develop full knee extension.
Heel Slides
Heel slides
Heel slides help in improving the range of motion after an injury. Remove the knee brace, and lie on a flat surface. Keep the legs straight, and arms straight against the sides. Bend your knees slowly, while sliding the foot across the floor. Bring the heel as close to the buttocks as is possible.
Once your knees are bent, slide back the foot to straighten your knees. This exercise has to be repeated five to ten times for each set. At least two to three sets should be done twice a day to improve knee flexibility before the surgery.
Phase I: 0 to 2 weeks
The rehabilitation for the ACL surgery begins a day after the surgery. During this phase the emphasis is solely on reducing the pain and the swelling which is caused by activity. An ice machine can help in reducing the pain and swelling, while the knee is protected by a postoperative knee brace. Some fluid drainage from the incision is quite normal. Change the dressing by removing the bandages, and keeping a gauze bandage over the surgical wound. Place a clean elastic dressing on top to keep the gauze in place. It is important to keep the incision dry for at least ten days after surgery. Crutches are to be used for one to two weeks after the surgery, and depending on the surgeon's preference, a brace can also be used.
ACL Surgery Recovery Exercises
It is important to regain the normal range of motion with initial physical therapy as soon as you can. This can be done under the guidance of a physical therapist. The goal of the physical therapy at this stage would be to increase the strength of the quadriceps and the hamstrings. In the later stage of recovery, a person can progress from partial weight bearing exercises to full weight bearing exercises.
Ankle Pumps
Ankle pumps
After the surgery it is important to exercise the legs so as to improve blood flow and prevent blood clots. This can be done with simple ankle pumps. To do this exercise, move the foot up and down as if pushing down and letting go of the gas pedal of the car. Do this exercise twenty five to fifty times after every two hours.
Passive Bending of Knee
Passive bending of knee
Sit in the chair while bending your knees. Cross the other leg over the surgery leg, and then slowly bend your knees. Allow the non-surgical leg to control and support the amount of bending.

This can be followed by active assisted extension wherein the non-surgical leg is placed underneath the surgical leg. While flexing the quadriceps, the knees are slowly straightened.
Straight Leg Raises
Straight leg raises
One of the important objectives of rehabilitation phase is exercising the quadriceps. Straight leg raises provide strength to the quadriceps while also improving the performance of the flexor muscles that are needed for walking.

To do this exercise, lie on your back, and then lift the leg off the ground to around forty five degrees. Hold the position for the count of six, before resuming position. This exercise has to be done ten times for each set, with around three sets at a time.
Hip Abduction (Side Lying Leg Lifts)
Hip abduction
Lie on the side, so that the uninjured leg is at the bottom and the surgical leg on top. Slowly raise the surgically repaired knee up towards the ceiling. Hold for some time, before lowering the leg again. This exercise can be done while wearing the knee immobilizer. After some days when the strength returns to the knee, remove the braces before doing the exercise.
Quadriceps Isometric Contractions
Quadriceps isometric contractions
To do this exercise, lie on the back with legs straight and toes pointing up. Slowly tighten the thigh muscles, while pushing the knee down towards the bed. Hold the position for five seconds before releasing. This exercise has to be done all day, nearly fifty to sixty times to strengthen the quadriceps.
During this phase, a patient will have the first postoperative office follow-up in which certain modifications to the physical therapy may be made. In the latter half of the second week after surgery, the incisions start to look much better. However, if there is increased redness, swelling, pain and bleeding from the knee joint, then call the doctor immediately.
Phase II: 2 to 12 weeks
Two weeks after the ACL surgery, the goals should be to maintain full extension, and achieve at least 100 to 120 degree flexion. The muscular control should be strengthened so as to wean off crutches. Regaining the gait, good balance and control are some other objectives of this rehabilitation phase.
ACL Injury Recovery Exercises
Along with the above mentioned exercises, other exercises for strengthening the muscle can be added to the daily routine. These include:
Partial Squats
Partial Squats
Step Ups
Step Ups
Bridge Pose
Bridge Pose
Short Lunges
Short lunges
Leg Press
Leg press
Functional exercises like walking and stationary cycling should also be added to the routine.
Phase III: 3 to 6 months
After three to six months, the goal is to regain full range of motion along with strength in the knees. An increase in agility that is characterized by changing direction, accelerating and decelerating can be observed during this phase.
ACL Injury Recovery Exercises
Along with the exercises done in phase 2, jump drills and plyometric drills that include jumping from blocks, landing on both the legs, jumping over blocks, and hopping down the stairs can be included in the routine.
Phase IV: 6 to 12 months
By six to twelve months, a person should be able to return to activities like sports. The quadriceps and hamstring strength should be at least eighty percent of the normal leg. There should be full motion and good stability. The person should be able to complete agility tests like the Zigzag test and Heiden Hop test. Isokinetic testing can be done to check muscle strength.
Common Questions After an ACL Surgery
When Can I Take a Shower after Surgery?
Showering is allowed after the dressing has been removed, ten days post the surgery. Till then the incision needs to be dry. Until the doctor gives a confirmation, do not soak the surgical knee in a bathtub, swimming pool or jacuzzi.
When Can I Drive after an ACL Surgery?
Driving can be resumed whenever the patient is comfortable. After two to three weeks, if he or she is no longer using crutches, and has a good control over his or her leg muscles, driving can be resumed. It is important to note that the patient should not drive while taking narcotic pain medications like Codeine.
When Can I get Back to Work?
Even people with desk jobs need to wait for a week or two before joining back. For others, the return to work will depend on the time taken for recovery, and how well the knee is protected against sudden, dangerous movements.

Although the process of recovery from an ACL surgery is drawn-out, it is possible to regain the full range of motion after following a comprehensive rehabilitation program. It is vital to consult a medical professional as well as a certified physical therapist before undergoing the above-mentioned phases of recovery.
Disclaimer : This article is for informative purposes only. Always consult a physician or a certified physiotherapist before starting any recovery exercises after a surgery.
Senior Lady having Knee Brace Fitted
Woman doing squats