Road to Recovery: ACL Surgery Timeline

Discover the step-by-step journey to recovery after ACL surgery with this comprehensive guide. From pre-surgery preparations to post-operative rehabilitation, learn about the timeline and milestones athletes can expect.

Pre-Surgery Preparations

Week(s) Prior to Surgery

Before undergoing ACL surgery, there are several important preparations that athletes need to make. First, it is crucial to find a skilled and experienced surgeon who specializes in ACL reconstruction. This ensures that the surgery is performed with precision and care. Additionally, athletes will need to undergo a thorough physical examination to assess their overall health and fitness levels. This may involve various tests, such as X-rays or MRI scans, to evaluate the extent of the ACL injury and any associated damage to the knee.

Days Prior to Surgery

In the days leading up to the surgery, athletes will need to follow specific instructions provided by their surgeon. This may include avoiding certain medications, fasting before the procedure, and arranging for transportation to and from the hospital. It is also important to mentally prepare for the surgery, as it can be a stressful and anxiety-inducing experience. Engaging in relaxation techniques, such as deep breathing exercises or meditation, can help alleviate any pre-surgery jitters.

The Day of the Surgery

Hospital Arrival

On the day of the ACL surgery, athletes will typically need to arrive at the hospital or surgical center several hours before the scheduled procedure. This allows time for pre-operative preparations, such as completing paperwork, changing into a hospital gown, and meeting with the surgical team. The surgeon will also have a final consultation with the athlete to address any last-minute concerns or questions.

Operating Room

Once in the operating room, the athlete will be administered anesthesia to ensure they are comfortable and pain-free during the surgery. The surgeon will then make small incisions in the knee to access the damaged ACL. Using specialized instruments, the surgeon will remove the torn ligament and replace it with a graft, which may be sourced from the athlete's own body (autograft) or a donor (allograft). The graft is secured in place using screws or other fixation devices.

Recovery Room

After the surgery is complete, athletes will be closely monitored in the recovery room until they wake up from the anesthesia. They may experience some pain and discomfort initially, but medications will be provided to manage any discomfort. It is important to follow the surgeon's instructions for post-operative care, including taking prescribed medications, keeping the surgical site clean and dry, and using assistive devices like crutches or a knee brace as needed.

Immediate Post-Operative Period

The immediate post-operative period is crucial for the success of ACL surgery. Athletes will need to adhere to a strict rehabilitation protocol to promote healing and prevent complications. This should involve working with a physical therapist to learn exercises that help restore range of motion, strengthen the surrounding muscles, and improve overall knee function.

What to Expect Post-Op

During this phase, athletes can expect to experience some swelling, bruising, and stiffness in the knee. Applying ice packs and elevating the leg can help reduce swelling and manage pain. It is important to carefully follow the surgeon's guidelines for weight-bearing and mobility, gradually increasing activity levels as tolerated.

Early Stage Rehabilitation

Rehabilitation is an essential part of the ACL surgery timeline. It involves a structured program of exercises and therapies designed to gradually restore strength, flexibility, and function to the knee. Athletes will continue to work closely with a physical therapist, who will guide them through various exercises and modalities.

Initially, the focus of rehabilitation will be on gentle range of motion exercises and basic strengthening exercises. Early on the focus is on restoring full knee extension (straightening) and active control of quadriceps muscle firing. 

Often, your therapist will use a device and technique called Neuromuscular Electrical Stimulation (NMES) to help activate your quad muscle in this early stage of ACL rehab. 

As the knee becomes less painful, with more stable from muscle function and has better range of motion, more challenging exercises will be introduced to help get the athlete walking normally, going up and down stairs and recovering day to day function.

During this phase of rehabilitation you are often in the physical therapy clinic 1-3x/week for more frequent hands on work with your therapist to regain your range of motion and restore basic muscle functions and movement.  

You should have a daily home exercise program to work on range of motion, quadricep activation and restoring normal walking.

Mid-Stage Rehabilitation

Mid-Stage ACL Rehab Exercises

During this phase of ACL rehab you are focused largely on regaining strength. Your therapist will assist you into returning to fundamental strengthening movements like:

• Lunges
• Squats
• RDLs
• Knee Extension
• Hamstring Curls
• Calf Raises

Late in this stage, you may begin some low level plyometric activities and pre-running drills to prepare your knee joint for impact. Exercises could include things like:

• Snap Downs
• Depth Drops
• A-Skips
• Pogo Hops

Commonly during this phase you are working with your physical therapist 1-2x/week in the clinic with a daily home exercise routine that will include additional strengthening work, conditioning and mobility. 

Late Stage Rehabilitation

This is where ACL rehab gets fun! The focus during this phase often shifts to restoring speed of movement, sport specific drills and advanced strengthening! 

Late Stage ACL Rehab Exercises

This stage will be the most variable based on the sport but might include exercises like:

• Band Resisted Lateral Shuffle
• Sprint to lateral stop
• Reactive Medball Sprinter Pass
• 3 Step Approach Box Jump

Progression through these stages needs to be gradual, systematic and based on objective criteria, not just time! Each athlete should have their strength, range of motion and jumping measured regularly to determine readiness to progress.

It is important for athletes to actively participate in their rehabilitation program, following the prescribed exercises and attending regular therapy sessions. This commitment and dedication to the rehabilitation process will greatly contribute to a successful recovery.

Return to Sports

Returning to sports after ACL surgery is a significant milestone for athletes. However, it is important to approach this phase with caution and patience to avoid re-injury. The timing for returning to sports will vary depending on the individual's progress and the specific requirements of their sport.

Return to Sports Evaluations

Before returning to sports, athletes should undergo a comprehensive evaluation by their surgeon and physical therapist. This needs to include functional testing to assess strength, power, and movement patterns. The athlete's readiness for sports will be determined based on their ability to perform sport-specific movements without pain, swelling, or instability.

Once cleared by the healthcare team, athletes can gradually reintroduce sports-specific activities and drills into their training regimen. It is important to continue with regular strength and conditioning exercises to maintain optimal knee function and reduce the risk of future injuries. 

Throughout the entire process, open communication with the healthcare team is vital. Athletes should report any pain, swelling, or instability during sports activities to their surgeon, physical therapist or athletic trainer. This allows for timely intervention and adjustments to the rehabilitation plan if necessary.

ACL Timeline Structure

By following the recommended ACL surgery timeline and diligently adhering to the rehabilitation program, athletes can increase their chances of a successful recovery and return to their beloved sports.

Kinetic Can Help You!

Are you going through an ACL rehabilitation right now, or possibly will be soon? Not sure where to start? At Kinetic, we are experts in ACL rehabilitation for athletes. We provide excellent Physical Therapy services for hundreds of ACL patients, and we also have a variety of online resources for anyone undergoing ACL surgery. Find out more from the links below, or contact us to see how we can help you today!

ACL Rehab Course

ACL Prehab Course

ACL Blogs

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