From the Guidelines
The recovery time after ACL repair typically ranges from 6 to 12 months before a full return to sports or strenuous activities is possible. This timeline is based on the most recent and highest quality study available, which emphasizes the importance of a gradual and structured rehabilitation protocol to ensure optimal outcomes and minimize the risk of re-injury 1.
Key Components of Rehabilitation
The rehabilitation process can be broken down into several key components, including:
- Immediate postoperative care, which focuses on reducing swelling and pain, and promoting gentle range of motion exercises and weight-bearing as tolerated with crutches
- Strengthening exercises, which begin as early as the first postoperative week with isometric quadriceps strengthening, and progress to concentric and eccentric exercises
- Neuromuscular training, which is added to strength training to optimize self-reported outcome measurements and prevent re-injury
- Sport-specific training, which begins between 3-6 months post-surgery and focuses on pivoting sports, with return to play typically not recommended until at least 9 months post-surgery
Factors Influencing Recovery
Recovery time can vary significantly between individuals based on factors such as:
- Age and overall health
- Pre-injury fitness level
- Surgical technique
- Compliance with rehabilitation protocols
- Presence of any concomitant injuries, such as meniscus repair or cartilage damage
Recommendations for Clinicians
Based on the available evidence, clinicians should:
- Initiate immediate knee mobilization and strength/neuromuscular training following ACL reconstruction
- Use cryotherapy immediately after surgery to reduce knee pain
- Add neuromuscular electrostimulation to isometric strengthening in the initial 6-8 weeks to re-educate voluntary contraction and increase strength of quadriceps muscles
- Prioritize close kinetic chain exercises in the first postoperative month and add open kinetic chain exercises (90-45°) as early as 4 weeks, without extra weight in the first 12 weeks for hamstrings graft
By following these recommendations and tailoring the rehabilitation protocol to the individual patient's needs and progress, clinicians can help optimize outcomes and minimize the risk of re-injury after ACL repair 2.
From the Research
Recovery Time After ACL Injury Repair
The recovery time after ACL injury repair can vary depending on several factors, including the individual's overall health, the severity of the injury, and the effectiveness of the rehabilitation program.
- The study 3 found that early rehabilitation after ACL reconstruction promotes better treatment outcomes, with distinct improvements in all physical symptoms in the damaged knee joint, regardless of the time elapsed from trauma to ACL reconstruction and from ACL reconstruction to rehabilitation.
- Another study 4 found that new protocols emphasize early weight bearing, open kinetic chain (OKC) exercises, and other alternative modalities, which can accelerate patient recovery.
- The study 5 provides evidence-based recommendations for the management of ACL rupture, including rehabilitation as first-line treatment, ACL reconstruction and post-operative rehabilitation, and pre-operative rehabilitation followed by ACL reconstruction and post-operative rehabilitation.
Factors Affecting Recovery Time
Several factors can affect the recovery time after ACL injury repair, including:
- The time elapsed from injury to surgical reconstruction 3
- The time elapsed from reconstruction to rehabilitation commencement 3
- The individual's overall health and fitness level
- The severity of the injury
- The effectiveness of the rehabilitation program 4, 5
Rehabilitation Protocols
Rehabilitation protocols for ACL injury repair can vary, but most include a combination of physical therapy, exercises, and other modalities to promote healing and restore function to the knee joint.
- The study 4 found that clinical milestones can be used to determine when a patient is ready for the next phase of a "step-up" rehabilitation program.
- The study 6 found that patients who undergo surgery must commit to appropriate rehabilitation for the best outcome.
- The study 7 found that early mobilization is often recommended to maintain range of motion and muscle strength, but the effects of early mobilization or unloading on long-term PTOA progression are unknown.