Recovery following an ACL reconstruction

What happens after the surgery?

After the procedure you will be taken to the recovery unit and then onto the ward. Some surgeons will perform the reconstruction as a day procedure, and you will be allowed to go home on the same day. Other surgeons, however, may want you to stay overnight. This will be discussed with you prior to the surgery but you shouldn’t have to spend more than one night in the hospital.

Your knee will initially be heavily bandaged and might be in a big knee brace called a range of movement (ROM) brace. This is used to give the knee some gentle support and to control excessive knee movement in the early stages. The brace will typically allow you to fully straighten your knee and bend up to 90°. The use of a ROM brace is again dependent on your surgeon and many surgeons are using them less often as the research around them changes.

You may have some painful bruising, swelling and redness around the knee and down to your ankle. This is a completely normal response due to the invasive nature of the reconstruction. You will be given medication and regular ice packs to help manage the pain and swelling.

A physiotherapist should see you soon after the surgery. They will give you further advice on how to best manage your knee at home for the next couple of weeks, and they will start you off with some basic exercises to get your knee straightening and bending well so that the knee doesn’t become too stiff and weak. Importantly they will show you how to walk with crutches on level ground and on stairs. You will be allowed to put as much weight as comfortable on the operated leg, but you may still need to use the crutches for a few weeks. Some of the advice and exercises that you will be given can include:

  • RICE or POLICE protocols as discussed previously to manage your pain and swelling.
  • Maintaining regular movement of the knee, and the whole body in general, often throughout the day.
  • Knee straightening and bending exercises that will help you to regain your movement.
  • Quadriceps strengthening exercises to improve the support around, and function of, the knee.

It is normal for the knee to be swollen and stiff for the first couple of weeks following an ACL reconstruction, and your surgeon will advise you regarding the best type of pain relief. During the first two weeks it is important to manage the swelling and movement by following the advice that you were given by the physiotherapist and surgeon. You do not normally need to see a physiotherapist within the first two weeks for rehabilitation as it is important to let the knee settle down before moving on to the next phase of rehabilitation.

You might have an appointment with a nurse after two weeks so that the stiches can be removed and then you will have a review with your surgeon, or a member of their team, at six weeks to check on your progress.

How long does it take to recover following an ACL reconstruction?

The amount of time taken to recover following an ACL reconstruction depends a lot on what it is that you want to achieve after the surgery. The recovery process can usually take between six months and a year. The higher the level of activity or sport that you would like to return to, the longer the recovery process can take.

You can gradually begin to return to your normal levels of activity between six weeks and six months after surgery. During this time, you will be encouraged to start varying levels of activity such as cycling, swimming, and even light running. Activities that involve a lot of twisting, jumping or change of direction should still be avoided at this stage as the ACL graft is still healing and strengthening.

After six months you may be able to return to some sports. However, this should only be under the guidance of your physiotherapist and surgeon. Many people will need to take more time to recover so that they can fully build up their confidence and strength. Elite athletes might return to sport much sooner than members of the general public, but it is important to remember that sport is often their job and they will have much more time to focus on their rehabilitation.

While there are rough guidelines for how long it can take to recover from an ACL reconstruction, it is more important that the recovery process is goal-based rather than timeframe based. This will ensure that you have the required components (strength, power, movement, balance) at each stage of the recovery process to prevent issues or re-injury later.

Do I need rehabilitation following an ACL reconstruction?

A structured rehabilitation program with a physiotherapist is highly recommended following an ACL reconstruction. As discussed above it is important to follow a goal-based rehabilitation program in order to achieve the best outcomes. A physiotherapist will be able to confidently guide you through the stages of recovery to ensure that you meet the desired goals at each stage. This will help you to return to your pre-injury level of sport and activity while minimising the risk of injury along the way.

There are seen to be five stages of ACL rehabilitation:

  • Phase One – Recovery from surgery
  • Phase Two – Strength and neuromuscular control
  • Phase Three – Running, agility, and landings
  • Phase Four – Return to sport
  • Phase Five – Prevention of re-injury

The rehabilitation process includes many different components that are used to achieve the goals at each stage. This may include:

  • Manual therapy / “Hands-on” treatment – Used in the initial stages to reduce pain and improve knee range of movement.
  • Balance exercises – To help retrain balance that is needed in all aspects of life and sport.
  • Strengthening and power exercises – Starting with body weight exercises and progressing to heavy weighted exercises in a gym.
  • Cardiovascular exercise – Cycling, swimming, cross-trainer, and running.
  • Plyometric exercises – Jumping and landing exercises that are important in many sports.
  • Sports specific exercises – These are later stage exercises that will help to build confidence and control for a successful return to your chosen sport.

Initially you may need to see your physiotherapist on a regular basis to make sure that the knee is recovering as expected, but as you progress through the stages you will not need to see them as often as the progress will not be as rapid and a lot of the emphasis will be placed on you to complete your rehabilitation independently. However, if you feel that you need more regular input or motivation then you can always discuss this with your physiotherapist.

What else can I do to help my recovery after ACL reconstruction?

There are some things, along with a comprehensive rehabilitation, that might be able to help your recovery following an ACL reconstruction.

Following a balanced diet before and after surgery will ensure that your body is getting all the nutrients that it needs to promote tissue healing. A balanced diet will also help with weight management which means that there can be less load through the knee. If you are unsure about the best nutritional approach to follow it might be useful to consult a dietician through Circle Health.

Maintaining a generally healthy lifestyle by reducing alcohol, caffeine and sugar intake, and stopping smoking could potentially improve your recovery. It is also important to make sure that you are getting enough sleep as your body repairs itself while you sleep.

Using supplements such as Glucosamine, Chondroitin and Omega-3 Fatty Acids might help with joint healing, inflammation and protection, but the research is still mixed on their use and this should be discussed with your surgeon.

ACL reconstruction: frequently asked questions

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