What to expect during your ACL rehabilitation

The physical therapists at Advance Physical Therapy have experience helping people achieve the most after their ACL surgery.  We follow the basic principle that our body knows how to heal itself if it is allowed to. Through monitoring the stages of healing and knowing when to make appropriate exercise progressions clients can return to their prior levels of function and beyond. Below is a summary of what to expect from your ACL recovery.

The rehabilitation process can be long, taking 3.5-6 months before returning to pre-injury level function; healing and functional gains continue up through the second year.  Achieving a full recovery is dependent upon several factors. The patient’s pre-injury fitness level and knee range of motion are factors which will dictate rates of progression and complexity of rehabilitation activities which will need to be later in the rehabilitation process.  The quality of physical therapy to assist in achieving specific mile stones in tissue healing, knee joint range of motion and re-establishing joint stability and neuromuscular control.  Patient compliance is critical in assuring that optimal functional outcomes are achieved.

The rehabilitation process for ACL reconstruction occurs in stages based upon graft tissue healing and its tolerance to accepting stress.  Various types of tissues are used for the ACL graft and have different healing considerations. Progressions in rehabilitation will vary depending upon the stage of tissue healing of the graft.  See the chart below for information regarding time frames for the goals of each healing stage.

Time Frame Based Healing Chart

Days 7-10	Goal: Protect the graft Promote healing Reduce swelling and pain Restore knee range of motion Teach appropriate weight bearing using crutches. Wear knee brace Issue neuromuscular electrical stimulation unit for quadriceps strengthening.
Weeks 2-4	Goal: Full knee extension Knee flexion passive range of motion should be 90 degrees. Ability to actively lift the leg while laying down keeping the knee perfectly straight. Minimal swelling and pain Use of 1 or 2 crutches during walking in and outside of their home Advance rehabilitation exercises to promote quadriceps muscle activation in standing, knee range of motion on a bicycle. Begin proprioception training wearing brace.
Weeks 4-7	Goal: Improve ambulation at home and in the community Unlocked knee brace to allow knee flexion during walking and sitting. Decrease use of crutches for short distance ambulation, Continue use of crutches for community distance ambulation. Knee flexion passive range of motion 130 degrees, active range of motion 115 degrees. Rehabilitation progressions for stepping, balance and proprioceptive training, Achieve full revolutions bike, increase resistance for promoting muscle activation, strength and proprioception.
Weeks 7-10Weeks 10-14	Goal:  Initiate activities to promote endurance and power.  Initiate simulation of functional activities. Initiate plyometric/jump training Initiate sport specific training.
Weeks 11-20	Goal: Maximize strength and neuromuscular control Prepare for a return to functional activities Accelerate sport specific training per inflammation reaction following training, surgeon satisfaction with ligament fixation and strength, and achievement of functional strength gains of 85-90% and dynamic control of 100% compared to the opposite leg with functional testing.
6 months	Goal: Discharge from physical therapy and resume prior activities. Issue ACL knee brace for sport and daily activities which stress the knee such as cutting and quick changes in direction
12 months	Goal: Follow up functional testing, ligament strength testing and isokinetic muscle testing

Written by Matthew Harwood PT, DPT, OCS