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How to Get Better After Reconstructing the Anterior Cruciate Ligament (ACL)

Recovering After ACL Reconstruction Surgery: This plan helps doctors know what to expect after ACL surgery. It follows both time and specific criteria based on how well the tissue heals. The treatment should be based on the individual’s needs, considering the exam results and clinical decisions. It also includes the expected timeframes for recovery.

Important Points [Click To go to the section]
Anterior Cruciate Ligament ACL Reconstruction (6)
Anterior Cruciate Ligament ACL Reconstruction (6)

The details in this guide may vary based on the surgeon’s preferences, additional procedures, or complications. If a doctor needs assistance with a patient’s recovery after surgery, they should consult with the surgeon who referred the patient.


Thinking about allograft and hamstring autograft options

For allograft and hamstring autograft, there are specific instructions for early weight-bearing and rehabilitation. Check the details below. The early return to sports may be delayed.


Considerations for multiple injuries

When you have more than one injury at the same time, it’s safer to be careful with how much you move, how much weight you put on, and how quickly you go through rehabilitation. This is especially important after a meniscus repair.

What to consider after surgery.

After surgery, watch for signs like fever, strong calf pain, too much drainage from the cut, or uncontrolled pain. If these happen, call your doctor immediately.

Swelling Management
  • Ice, pressure, and incline (for cold treatment, talk to your doctor first).
  • Backwards massage
  • Foot pump
Ice, pressure, and incline (for cold treatment, talk to your doctor first).
Backwards massage:
Foot pump:
Mobility or freedom of movements

Move your kneecap in two ways: up and down, and side to side. This is crucial in the initial weeks after surgery with a patella tendon graft.

Bend and straighten your knee, and slide your heel while sitting with the aid of a towel.

Perform gentle, prolonged stretches to extend your knee: try prone hanging and heel prop. Stretch your calf muscles while standing and stretch your hamstrings while lying down and keeping still.

Patellar mobilizations:
Seated assisted knee flexion extension
Heel Slides With Towel
Low intensity, long duration extension stretches: Prone Hang
heel prop
Standing gastroc stretch
Soleus Stretch

Supine Active Hamstring Stretch
Supine Passive Hamstring Stretch
Calf Raises
Quadriceps Setting Exercise

NMES: high intensity (2500 Hz, 75 bursts) Supine knee extension: 10 sec/50 sec, 10 contractions, 2x/wk during sessions. Use clinical stimulator during sessions and explore home units for immediate post-op.

Straight Leg Raise Exercise **Do not perform straight leg raise if you have a knee extension lag
Hip Abduction
Multi Angle Quadriceps Isometric
Criteria to Progress
Knee Extension 0 to 45 degrees
Patella Mobilizations with Paul Marquis PT
Able to perform straight leg raise without lag


Rehabilitation Goals
  • Continue to protect graft
  • Maintain full extension, restore full flexion (contra lateral side)
  • Normalize gait
Additional Interventions *Continue with Phase I interventions

Range of motion/Mobility

Gentle stretching all muscle groups:

Patella Mobilizations with Paul Marquis PT : Prone Quad Stretch
Standing Quad Stretch
Standing Quad Stretch
Kneeling Hip Flexor Stretch


Prone Hamstring Curls
Prone Hamstring Curls
Step Ups with March
Partial Squat Exercise
Ball Squats
Wall Slide Exercise
Wall Slide Exercise
Lumbopelvic strengthening:
Criteria to Progress
  • No swelling (Modified Stroke Test)
  • Flexion ROM within 10 deg contra lateral side
  • Extension ROM equal to contra lateral side


Benefits Of Climbing Stairs 4
Strengthening Gym equipment:

o Hamstring autograft can begin resisted hamstring strengthening at 12 weeks

  • Progress intensity (strength) and duration (endurance) of exercises

**The following exercises to focus on proper control with emphasis on good proximal stability


Progress single limb balance including perturbation training

Rehabilitation Goals

  • Continue strengthening and proprioceptive exercises
  • Symmetrical performance with sport specific drills
  • Safely progress to full sport
    Additional Interventions
    *Continue with
    Phase II-V
  • Multi-plane sport specific plyometrics program
  • Multi-plane sport specific agility program
  • Include hard cutting and pivoting depending on the individuals’ goals (~7 mo)
  • Non-contact practice→ Full practice→ Full play (~9 mo)
    Criteria to Progress
  • Functional Assessment
    o Quad/HS/glut index ≥95%; HHD mean or isokinetic testing @ 60d/s
    o Hamstring/Quad ratio ≥66%
    o Hop Testing ≥95% compared to contra lateral side, demonstrating good landing
  • KOOS-sports questionnaire >90%
  • International Knee Committee Subjective Knee Evaluation >93

This program is intended to lead professionals and patients through a stepwise return-to-run program. Prior to starting this program, patients should have a Functional Assessment score of at least 80% (after knee ligament or meniscus repair). Specific advice should be based on the individual’s needs, and clinical

Decision making. If you have questions, please contact the referring physician.

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running is one of the best ways to stay fit royalty free image 1036780592 1553033495
Screenshot 2024 03 05 200024


  • Runs should occur on softer surfaces during Phase I
  • Non-impact activity on off days
  • Goal is to increase mileage and then increase pace; avoid increasing two variables at once
  • 10% rule: no more than 10% increase in mileage per week

This program guides physicians and patients through a series of agility and plyometric exercises to encourage a successful return to sport while reducing injury risk. Before starting this treatment, patients should score at least 80% on the Functional Assessment. Individualized interventions should take into account clinical decision-making. If you have questions, please contact the referring physician.



Single leg (these exercises are challenging and should be considered for more advanced
Single leg (these exercises are challenging and should be considered for more advanced

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