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Recovery After Anterior Cruciate Ligament (ACL) Reconstruction Surgery
ACL reconstruction surgery is a procedure in which the torn anterior cruciate ligament is removed and replaced with a new graft. This graft (commonly taken from the hamstring tendons, patellar tendon or quadriceps tendon) is fixed into the bones of the knee using screws, buttons or other fixation devices. The aim of the surgery is to restore normal knee stability and function and to allow a safe return to daily activities and sports.
After the operation, pain and swelling are expected for the first days and weeks. To reduce these symptoms, your surgeon may recommend ice application, elevation of the leg, compression bandages and pain-relieving medications. Depending on the surgical technique and whether additional procedures were performed (for example, meniscus repair or cartilage treatment), you may need to use a knee brace or splint for a few weeks. Crutches are usually needed in the early period to protect the graft and control weight bearing.
A structured physiotherapy and exercise program is essential after ACL reconstruction. Physical therapy focuses on:
- Reducing pain and swelling,
- Regaining knee range of motion (especially full extension),
- Rebuilding quadriceps and hamstring strength,
- Improving balance, coordination and neuromuscular control,
- Preparing safely for running and, later, return to sports.
The overall recovery process varies from person to person. Age, general health, the severity of the initial injury, any additional ligament or meniscal injuries, the type of graft used and the quality of the rehabilitation program all influence healing. An important goal of postoperative rehabilitation is not only to restore function, but also to prevent re-injury of the ACL.
Typical Phases of Recovery After ACL Reconstruction
First Week (0–7 days)
- Knee pain, bruising and swelling are most prominent during the first few days.
- Ice application, elevation of the leg and prescribed medications help control symptoms.
- A brace or splint may be used to protect the knee and limit certain movements.
- In most cases, gentle range of motion exercises, ankle pumps and quadriceps activation exercises are started early, as directed by your surgeon or physiotherapist.
- Walking is usually done with crutches; weight bearing is gradually increased according to your surgeon’s instructions, especially if meniscus repair has also been performed.
Weeks 1–2
- Pain and swelling generally begin to decrease.
- Knee motion improves; the goal is to reach full extension and gradually increase flexion.
- Physiotherapy focuses on restoring normal gait, reducing stiffness and activating the thigh muscles.
- Simple daily activities (short walks at home, standing for longer periods) become more comfortable.
Weeks 2–6
- Physiotherapy and home exercises continue on a regular basis.
- Walking becomes more stable; most patients gradually wean off crutches during this period, depending on pain, muscle control and any additional procedures.
- Strengthening exercises (closed chain exercises, stationary bike, light resistance work) are progressed as tolerated.
- Focus is placed on achieving nearly full range of motion and normalizing walking pattern.
Weeks 6–12
- More challenging strengthening and balance exercises are introduced.
- Patients usually return to many routine daily activities and, in many cases, to office-type work or light duties if their job is not physically demanding.
- Low-impact cardiovascular exercises (bike, elliptical, brisk walking) are often added to improve endurance.
- The knee should feel more stable, but the graft is still in a healing and remodeling phase, so sudden pivoting and high-impact activities are avoided.
Months 3–6
- By this stage, most patients achieve near-complete recovery of knee movement and strength compared to the other side.
- Progressive running programs are usually started around the end of the 3rd month, provided pain and swelling are minimal, range of motion is full and strength is adequate.
- Sport-specific drills, cutting and pivoting exercises and higher-level balance/coordination training are gradually introduced closer to the 5th–6th months, under professional supervision.
- Even if the knee feels “normal”, the ACL graft is still maturing. Close follow-up with your surgeon and physiotherapist is important to avoid returning to high-risk activities too early.
Driving, Running and Returning to Sports
In most patients, safe driving is not recommended before 4–6 weeks after surgery, especially if the operated leg is the right leg and you drive a car with a manual gearbox. You should have sufficient muscle control, reflexes and confidence to perform emergency braking safely. Always follow your surgeon’s specific advice on this.
Running is usually allowed around the end of the 3rd month, provided that:
- There is no significant pain or swelling in the knee,
- Knee motion is full (especially extension),
- Quadriceps and hamstring strength are close to the opposite side,
- Balance and neuromuscular control exercises have been successfully completed.
Return to sports is typically considered around the end of the 5th–6th month at the earliest. However, it is important to remember that the biological maturation of the ACL graft continues for approximately 12 months or longer. Without intensive, sport-specific physiotherapy and strict adherence to the rehabilitation program, returning to contact or pivoting sports too early (for example, at 5–6 months) can be risky.
A safe return to sports does not depend only on time passed after surgery. Before going back to high-level activity, the following criteria should be met:
- Muscle strength (especially quadriceps and hamstrings) should be sufficient and symmetrical,
- There should be no pain, giving way or significant swelling in the knee,
- Knee range of motion should be complete or very close to the other side,
- Balance, coordination and neuromuscular control should be restored,
- Functional tests (single-leg hop tests, agility drills, etc.) should be satisfactory according to your physiotherapist or surgeon.
Always discuss your individual progress and goals with your surgeon and physiotherapist. They will guide you on the safest time and conditions for returning to your sport or physically demanding job.
Frequently Asked Questions About ACL Reconstruction Recovery
How long will I stay in the hospital after ACL reconstruction?
Hospital stay is usually short. Many patients go home on the same day or stay one night, depending on the hospital protocol, pain control and any additional procedures performed (such as meniscus repair). Your surgeon will decide the safest time for discharge.
When can I put full weight on my operated leg?
This depends on the details of your surgery. After isolated ACL reconstruction, partial weight bearing with crutches often begins immediately or within a few days, progressing to full weight bearing over the first 2–4 weeks. If a meniscus repair or cartilage procedure was also performed, weight bearing may need to be restricted for a longer period. Always follow the specific instructions given by your surgeon and physiotherapist.
Is pain and swelling normal after ACL surgery?
Yes. Pain, swelling and bruising are common in the early postoperative period. These symptoms should gradually improve with ice, elevation, rest and prescribed medications. However, increasing pain, rapidly worsening swelling, fever, redness or discharge from the wounds are not normal and should be evaluated by your doctor.
When can I drive again?
Most patients can drive safely after about 4–6 weeks, provided they have sufficient muscle control, knee motion and reflexes, and are not taking medications that impair reaction time. If your right leg is operated on, it may take longer to regain safe braking ability. Always ask your surgeon for personalized advice before resuming driving.
When can I start running?
Running is usually considered around the end of the 3rd month, if there is no significant pain or swelling, knee motion is complete and strength and balance are adequate. Your physiotherapist may start you on a graded running program on a treadmill or flat surface and will monitor your symptoms closely.
When is it safe to return to sports?
For most patients, the earliest safe time to return to pivoting and contact sports is around 5–6 months after surgery, and often later, depending on the sport and individual progress. Time alone is not enough: adequate strength, balance, neuromuscular control and successful completion of sport-specific functional tests are essential. Premature return to sport increases the risk of re-injury.
How can I reduce the risk of re-injury to my ACL?
Completing a full rehabilitation program, continuing strengthening and neuromuscular training even after returning to sports and following your surgeon’s and physiotherapist’s recommendations are the most important factors. Proper warm-up, strengthening of the hip and core muscles, balance and landing technique training, and avoiding sudden increases in training intensity all help protect your knee and new graft.
When should I contact my doctor after surgery?
You should contact your doctor urgently if you experience any of the following:
- Fever, chills or feeling generally unwell,
- Rapidly increasing pain or swelling in the knee or calf,
- Redness, warmth or discharge from the incision sites,
- Sudden, unexplained locking or giving way of the knee,
- Shortness of breath or chest pain.
In addition, if you feel that your recovery is not progressing as expected or you have concerns about your exercises or activities, you should discuss them with your surgeon or physiotherapist.
