ACL Rehab Part 2 - Post-Op

Immediate ACL Surgery Recovery: How to Get it Right, Early. 

You’ve finally had the ACL surgery. Now it’s time to start thinking about the rehab road ahead. It can be intimidating trying to negotiate the maze that is ACL rehab. Luckily for you, we are here to help you navigate your recovery journey. 

In our last post, we talked about the importance of preparing yourself for your surgery (check it out if you haven’t seen it).  

In this post, we are diving into the first stage of the rehabilitation process.

Nailing the immediate recovery into the first few weeks is pivotal for setting the foundations for a better rehab and recovery process. 

We’ll walk you through:

• The very first phase of ACL rehabilitation
  
  
• How to track your recovery progress at home
  
  
• What milestones you’ll need to hit before moving forward
  
  

Let’s break it down.

Walking 

Usually after ACL surgery you will be given some crutches and likely fitted with a knee brace. 

The surgeon will let you know how much weight you can put through the leg. They may also use the brace to limit some of your knee movement.

This decision is made due to the procedure performed as well as any concurrent injuries such as meniscus injuries or other ligament injuries. 

They will also tell you how long you need to follow these restrictions for. It is important to follow this to give your knee the best chance to heal. 

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Recovering from surgery 

Recovery starts  the moment you get home. It’s not about pushing hard. It's about getting the basics right so you can set yourself up for success in later stages.

You have some key goals you want to work towards in the first few weeks 

✅ 1. Restore Range of motion

• Regaining full knee extension (getting your knee fully straight) is your first big milestone and is particularly important to work towards.
  
  
• Not getting your knee straight can lead to issues down the line so getting this going early is a must
  
  
• Bending the knee is also important to work on but getting the knee straight is the real key to this phase
  
  
• Gentle knee bending and straightening exercises can begin straight away which can include heel slides for bending and static quad squeezes for straightening
  
  

✅ 2. Get the Quads Firing Again

• After surgery, the quads (the big muscles at the front of your thigh) can often become inhibited by your brain. Pain and swelling can also contribute to this inhibition of the muscle
  
  
• Getting the quads firing again is super important before you progress onto harder exercises
  
  
• Ways to get the quads firing include
  
  • Isometric knee extensions
  • Small knee bending and straightening exercises 
  • Small squats
  • Heavy work on the opposite leg (whilst being safe) can help wake up those quads!
  • Neuromuscular electrical stimulation: gives a small electrical stimulus to the muscle to help it contract properly again.
    
    

✅ 3. Control the Pain and Swelling

• Swelling = pain, stiffness, and poor quad activation.
  
  
• This can limit how quickly you get your quad activation and range of motion back. So it’s important to keep it in check.
  
  
• Try this combo:
  
  
  
  • Regular icing (20 minutes at a time, a few times a day)
    
    
  • Compression sleeves or bandages
    
    
  • Elevate your leg whenever you’re resting
    
    

💡  Tip: Using compressive cryotherapy (compression + icing at the same time) may be even more effective than just icing alone.

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3. Tracking Your Progress: What to Watch For

Your physiotherapist will be tracking your recovery closely, but here’s how you can keep tabs on things at home:

Key Indicators:

• Pain (rated from 0 to 10)
  
  
  
  • Try to keep it below 2/10 during activity
    
    
  • Monitor how pain responds to walking or simple movements
    
    
• Swelling
  
  
  
  • Expect some swelling early on, but it should reduce steadily
    
    
  • You can measure the circumference of the swelling with a measuring tape
    
    
• Quads Lag
  
  
  
  • Lay on your back and keep your knee straight. Then try to lift the leg without letting the knee bend
    
    
  • Once you can do this easily, we know that the quads have woken back up!
    
    

Common Mistakes to Avoid

🚫 Pushing too hard, too soon
🚫 Ignoring swelling or pain
🚫 Taking off your brace before you're cleared to do so
🚫 Skipping the small exercises 

Remember: Progress in this phase isn’t about smashing workouts, It’s about getting the basics right to set you up for the later stages.

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Conclusion & Key Takeaways

The first phase of ACL rehab sets the tone for everything that comes next. Whilst it might all seem simple, it’s important you get this right to lay the foundations for the rest of your rehab journey 

Focus on getting your knee straight, reactivating your quads, and managing swelling and pain - and don’t rush it.

Listen to your body and don’t push too quickly into pain and keep an eye on any spike in swelling or pain - it’s a sign you are doing too much, too soon!

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What’s Next?

Stay tuned - our next post will tackle Part 3: Building Strength & Control, where you’ll finally start to feel like you’re getting somewhere again.

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👉 Need help with your ACL rehab plan?

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Book a session with one of our experienced physiotherapists on the website, or send us a DM on instagram. we’re happy to guide you through it.

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References 

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1. Buckthorpe, M., Gokeler, A., Herrington, L., Hughes, M., Grassi, A., Wadey, R., Patterson, S., Compagnin, A., La Rosa, G. and Della Villa, F. (2024) Optimising the early-stage rehabilitation process post-ACL reconstruction. Sports Med. doi: 10.1007/s40279-023-01934-w
2. Cooper, R. and Hughes, M. (2018) Melbourne ACL Rehabilitation Guide 2.0: A criteria driven ACL rehabilitation protocol and guide for both clinicians and people who have undergone a surgical reconstruction of the Anterior Cruciate Ligament (ACL). Melbourne: Melbourne Sports Medicine Centre.
3. Cunha, J. and Solomon, D.J., 2022. ACL prehabilitation improves postoperative strength and motion and return to sport in athletes. Arthroscopy, Sports Medicine, and Rehabilitation, 4(1), pp.e65-e69. Available at: https://doi.org/10.1016/j.asmr.2021.11.001 [Accessed 24 February 2025].
4. Kotsifaki, R., Korakakis, V., King, E., et al., 2023. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 57, pp.500-514.[Accessed 18 February 2025].

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