One of the first questions for someone who has torn their ACL is how long after surgery will it be before they can return to their normal lives and activities. Here we discuss the ACL surgery recovery timeline using the ACL rehab protocol offered by MOON (Multicenter Orthopaedics Outcomes Network).
Individual medical plans and/or local health services will determine how quickly surgery can occur after injury but there are several knee strengthening exercises that can prepare the patient for surgery and ensure a shortening of the ACL recovery timeline.
One of the major determinants for the ACL surgery recovery timeline is the type of graft chosen for ACL surgery. If a graft is taken from the body of the patient then a second trauma is introduced that a) requires time to heal and b) is painful and slows recovery. Using a cadaver graft eliminates this second trauma and ensures a much quicker recovery time. The downside of using a cadaver graft is that it may not be as strong as a graft taken from the patient’s own body and certainly would not be applicable for a professional athlete.
Diet also has a major impact on the ACL recovery timeline. Some foods cause chronic inflammation in joints whereas others work to reduce inflammation. Eating the right foods can then have a positive impact on ACL recovery time and you can read more about those foods here.
You can read about my own personal recovery timeline at ACL Recovery Timeline – The Reality. General guidelines and stages for recovery from ACL injury follow.
The Multicenter Orthopaedics Outcomes Network (MOON) offers an excellent ACL rehabilitation program and I borrow their timeline for ACL recovery:
The 2 weeks after surgery
- Focus on range of motion, reduction of swelling, pain minimization
- Good quadriceps control (quad sets, single leg raise lifts)
- Work on gait (ability to walk without a limp)
From 2 to 6 weeks
- The target is to achieve full range of motion which means being able to straighten the leg and get to 135 degrees of bend – this might be difficult if a graft other than a cadaver is used because of the healing required at the second trauma point
- The patient should be well into physical therapy by the second week and working to improve muscle strength using squats and leg presses
- Ideally between the fourth and sixth week neuromuscular training can begin using a wobble board
- Non-weight bearing cardio work can also begin, e.g. using a stationary bike, elliptical trainer, or stairmaster
From 7 to 12 weeks
- One extremely important point to note when recovering from ACL reconstruction surgery is that the graft is at its weakest between weeks 6 and 10 after surgery. Unfortunately this corresponds with the period when the patient can start moving more normally so extreme care needs to be taken during this period
- For example, the patient can start running again but must only do so in a straight line and on a smooth surface. Sudden pivot moves or simply tripping can easily result in the ACL being torn again
- This phase post-surgery should also allow the patient to begin hopping without pain or having the knee give way
- Outdoor cycling can now also be introduced although care needs to be taken not to twist the knee when stopping. Try to remember to set the unharmed leg down and avoid using pedal clips until recovery is complete
From 13 to 16 weeks
- Running patterns (figure of 8, pivot drills etc) at 75% speed
- Jumping without difficulty
- Hop tests
From 17 to 20 weeks
- Return to sport phase
- Aggressive strengthening and regular testing to ensure progression criteria are met
- Kicking in soccer
- Spiking in volleyball
- Pivot and drive in basketball
The potential is there, therefore, for a return to sporting activity 5 months after ACL surgery. This must be viewed, however, as very much a best case and requiring total dedication to the rehabilitation program. The reality for all but the professional athlete will be a 6-9 months recovery timeline for ACL surgery.
One final note. The body is amazingly adept at accommodating pain, by which I mean that, for example, your brain will change the way you walk to prevent painful knee bend. Unless you check for a perfect gait you may find that your leg is swinging outward when you walk. If this is not corrected it can cause long term weakness in the knee and contribute towards a repeat ACL tear.