ACL Surgery Recovery: Expectations and Timeline

By Dustin C. Dyer, DO

If you are scheduled to have surgery for your ACL injury, or have recently undergone surgery, you may wonder how long it will take to recover. When can you run or play sports again? What will physical therapy be like?

The most important thing to remember about your recovery is to manage your expectations. For example, NFL athletes who suffer ACL injuries take eight months on average to fully recover. You should not expect a full recovery in just a few weeks. Instead, concentrate on performing every exercise and physical therapy activity correctly. It is also very important to follow all restrictions and recommendations from your surgeon and physical therapist. Do this and you’ll stand a much greater chance of an efficient, stable, and long-lasting recovery.

The Day of Surgery

These days, most ACL surgeries are outpatient, which means no overnight stay in the hospital. Before surgery, the anesthesiologist will administer a nerve block which numbs the nerves that send pain signals to the knee. This will give the patient a head start on the first twenty-four hours of pain control. You can start icing and elevating the knee right away — which will be critical for a proper recovery.

The First Two Weeks

For the first two weeks, you will most likely be using crutches and a hinged knee brace. This brace will initially be locked straight, because the quadriceps muscle tends to get weak after an ACL injury. If not braced, the knee may buckle, risking re-injuring the ACL. The knee can tolerate bearing weight, but must be kept straight when walking until the physical therapist or physician deems otherwise.

These first two weeks will focus on icing the knee (to reduce swelling) and range of motion activities. Heel slides and extension stretching are common activities. Obtaining full extension of the knee is important, because it is associated with a more complete recovery. The more you ice and elevate the knee throughout the first two weeks, the better your knee will feel (thus improving your recovery). A general goal is have range of motion from zero to 100 degrees by two weeks.

The First Three Months

At five to six weeks, the quadriceps muscle is likely recovered enough to support normal walking with your hinged knee brace unlocked. The decision to unlock or remove your brace will be made by your surgeon or physical therapist. From here, a good physical therapy routine and home exercise program are key. A patient that stays motivated and complies with restrictions will excel. Keep in mind that every patient is different, and recovery time and difficulty will vary depending on circumstances.

At this point, the physical therapist will continue to teach closed chain exercises, in which the the foot is planted and the patient works on strengthening the muscles around the knee. Strengthening the quadriceps muscle can help with normal ambulation, while strengthening the hamstring muscle can play a protective role for the healing ACL. Core strengthening, stretching and maintaining excellent range of motion are all vital to the rehab process as well.

Around the three-month mark, you may be able to start running in-line, though you likely will not be performing any cutting or pivoting exercises yet. Sports-specific cutting and pivoting exercises are likely to start five to six months after surgery.

Six to Eight Months

After six months (or longer), the physical therapist may administer a series of functional tests: agility tests, vertical jump tests, hop tests, etc. These tests are designed to determine the level of recovery and see if further physical therapy is necessary. The full recovery may take six months, eight months, or longer. It depends on the patient.

Many patients wonder if they will require an ACL brace after their surgery when they return to their sport or activity. While there is no definitive evidence that all ACL injury sufferers need a brace, there are certain athletes that prefer to wear them. Especially athletes that will be participating in contact sports. The best course of action is to consult with your physician and physical therapist regarding this matter.

If you have questions about ACL injury, surgery, or the recovery process, reach out to Tuckahoe Orthopaedics to request an appointment and get your questions answered.

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