How Long Does ACL Tear Surgery Recovery Take?

A tear in the anterior cruciate ligament requires ACL surgery, and a recovery time of about six months before you can return to athletic activity. ACL reconstruction surgery is a common approach to repairing a ruptured ACL.

When combined with a structured rehabilitation program, a person can often return to sports at the same level of play they enjoyed before the injury. Even so, ACL rehabilitation takes months. 

Timeline of Recovery

After ACL reconstruction surgery, the rehabilitation process is broadly divided into five phases, from immediate post-operative recovery through the return to sports.

Phase 1: Week 0-2 (Immediate Post-Operative Recovery)

The goals of the first days following ACL reconstruction are to minimize swelling and prevent discomfort. This can be accomplished with:

• Frequent ice application
• Elevation of the affected knee
• The use of crutches

Range of motion exercises can begin almost immediately after surgery. The initial focus is to regain full knee extension (the ability to straighten the knee). Flexion (the ability to bend) is much easier to recover than extension.

After the first week of recovery, your physical therapist (PT) will start you on gait training, gentle strengthening, and aerobic exercises. Some PTs like to use stationary cycles as soon as possible, improving strength, motion, and aerobic fitness.

Some surgeons may recommend a knee brace after ACL surgery. This is controversial, and many orthopedists avoid using them due to the lack of evidence that they actually help. Discuss the pros and cons with your surgeon.

Starting to work on mobility immediately is considered an important part of recovery. While bed rest used to be recommended in previous years, staying immobile for extended periods (outside of sleep and rest) could make recovery harder.

Phase 2: Weeks 3-6

During Phase 2, work is continued with physical therapy. As the range of motion increases, the emphasis is shifted from knee extensions to strengthening the muscles around the knee. Balance and proprioceptive exercises (which help your body know where it is in space) are key parts of Phase 2.

You should be able to resume driving at the start of this phase.

Phase 3: Weeks 7-12

During this phase, sport-specific activities can be started when the following are achieved:

• Full range of motion in the knee is near normal.
• Swelling in the knee is entirely gone.

Early sports activities that can be started during Phase 3 include light jogging, outdoor cycling, and pool workouts. Side-to-side, pivoting sports—such as basketball, soccer, and football—must be avoided.

Phase 4: Months 3-6

By three months, you should be at regular daily activities and can continue to work on sports-specific activities. You can ease into running during this phase.

Over time, sports drills can be incorporated into the plan. For example, a tennis player may start light-hitting, while a soccer player might engage in controlled dribbling.

This rehabilitation phase is often the most difficult because people may have a knee that feels normal but is not yet ready for the stresses of strenuous sports.

Phase 5: Month 6+ (Return to Sports)

Phase 5 can take anywhere from six months to a year depending on the extent of the injury, the type of graft used, and other factors. During this phase, the focus is placed on sport-specific motions and activities under the supervision of a PT or sports medicine practitioner.

At the end of Phase 5, your orthopedic surgeon can assess whether you can safely return to sports.

Returning to Sports Fully

Deciding when to return to unrestricted sports activities depends on several factors, including:

• Functional progression: The decision to return to sports is based on each individual's progression through their physical therapy program.
• Graft type: Some surgeons may delay return to sports if the graft used to reconstruct the ACL came from a donor. Because these grafts are sterilized and frozen, the process can delay healing in some people.
• Surgeon preference: Your orthopedic surgeon will guide your rehabilitation and make the ultimate decision as to whether you can return to sports.

Some people will try to rush things and ignore their surgeon's recommendation. The consequences of this can be catastrophic, leading to re-rupture and another possible round of surgery.

By way of example, former NFL wide receiver Jerry Rice famously made a comeback 3.5 months after undergoing ACL reconstruction in 1997. In his first game back, he fractured his kneecap from where the graft was taken from. The new injury ended his season before it barely began.

Preventing Re-Injury

The time it takes to recover from ACL reconstruction surgery can vary from one person to the next. Numerous factors can influence recovery times, including:

• The type and severity of ACL injury
  
• Body mass index (BMI)
• A person's anatomy
• The type of sport a person plays as well as the level of play
• The type and size of the graft
• The level of adherence to the rehabilitation plan

Of all the factors listed above, there is only one you can fully control: how strictly you follow the rehabilitation program. Commitment is key to an unrestricted return to sports.

Summary

Recovery from cruciate ligament (ACL) reconstruction surgery takes time and patience. The rehabilitation plan, overseen by an orthopedic surgeon and facilitated by a physical therapist, is typically structured in five phases, from immediate post-operative recovery to the return to sports. The process generally takes six months and possibly longer.

Recovery from ACL reconstruction is influenced by several factors, including the severity of your injury, the type of graft you have, the sports you engage in, the level of play, and your commitment to the rehabilitation program. This last factor is arguably the most important and the one you can fully control.