ACL Surgery: Recovery

Anterior cruciate ligament (ACL) tears are commonly repaired with arthroscopic surgery. During ACL surgery, the torn ligament is replaced with a tendon graft in order to restore knee function. While the operation is generally quick and performed in an outpatient center, the recovery and rehabilitation process are extensive and require close follow-up and dedication on your part.

Surgery Follow-Up

Appointments with your healthcare provider are generally scheduled at the following points after surgery:

• One week
• Two weeks
• Six weeks
• Three months
• Six to eight months

During these appointments, your surgeon will evaluate your knee's range of motion, strength, and functioning. They will also monitor for any complications, such as wound infection or persistent knee pain and stiffness.

Besides meeting with your surgical team, you will begin physical therapy immediately after surgery. Your physical therapist will determine the appropriate rehabilitation program for you based on a number of factors like your age, health status, and fitness level.

ACL rehabilitation generally takes four to six months. The main goals of rehabilitation include:

• Regaining the ability to fully straighten and move your knee
• Restoring quadriceps and hamstring muscle strength
• Decreasing and eventually eliminating knee swelling and pain
• Gaining back full sense of balance and leg control

Recovery Timeline

Recovery from ACL surgery begins in the recovery room where a nurse will monitor your vital signs and help you manage common post-operative symptoms like pain and nausea.

Once you are stable and comfortable enough to go home (which is usually around two to three hours after surgery), you will be discharged with post-operative instructions. A family member or a friend will need to drive you home.

For the first two weeks after surgery, your surgeon will likely suggest the following:

• Icing your knee regularly to reduce swelling and pain.
• Using crutches to keep weight off of the leg that was operated on.
• Wearing a special post-operative brace and use a continuous passive motion (CPM) machine (based on surgeon preference).

In terms of activity restrictions, most patients can start driving two weeks after surgery. Patients can return to work within a few days to a few weeks, depending on the nature of their job. Returning to playing sports takes much longer, usually four to six months.

Coping With Recovery

Coping with recovery after ACL surgery involves addressing both your physical and psychological needs.

Physical Needs

Your body needs more than time to recover properly and well from ACL surgery. You can aid in your recovery, and the speed at which it happens, by following your healthcare provider's instructions fully.

Among some of the basic recommendations:

• Taking your medications as prescribed. You will be on pain medication—often a combination of local anesthetics, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs)—after surgery. Talk to your healthcare provider about how and when to take them and any other new medications. If you stopped medications before your surgery, be sure you are clear about when to restart them.
• Ensuring proper nutrition. Eating well after surgery can help prevent complications and improve wound healing. Nutritional guidance often includes consuming lean protein (red meat, chicken, or fish) and ensuring adequate calorie intake.
• Getting ample sleep. While you sleep, your body repairs tissues and promotes healing, so be sure to get at least eight hours of quality sleep each night. It's best to learn and follow techniques that promote sleep rather than reaching for sleeping pills.

Psychological Needs

Stress and mild anxiety are normal after experiencing an ACL injury and undergoing surgical repair. It may also be hard to be sidelined for a bit, especially if you are used to being very active or independent.

Some people, though, experience more debilitating psychological responses after surgery. They may have an exaggerated response to actual or anticipated knee pain, or they may fear re-injury to the point that they do not return to sports activities when healed. Patients, especially younger athletes, may experience symptoms of post-traumatic stress disorder (PTSD)—such as sleeping problems and poor concentration—after an ACL injury.

To prevent psychological factors from impacting your emotional well-being and recovery, consider these strategies:

• Talk with your surgeon and physical therapist: Recognizing and discussing potential psychological barriers (e.g., fear of pain or re-injury) is an important first step. To address these thoughts/factors, your surgeon may recommend a physical therapy approach that incorporates cognitive-behavioral techniques.
• Use relaxation techniques: Research suggests that optimism and using guided relaxation techniques (e.g., guided imagery) can promote healing after surgery. Consider using audio recordings, podcasts, or a professional telehealth instructor to help keep you calm during this stressful time.
• Ask for help: After surgery, you will be less mobile and will need assistance with daily chores around the house for the first two weeks. Don't be afraid to ask for help from your friends and family during this short-lived, but challenging time. This can reduce stress on both your body and your mind.

Wound Care

You will most likely have two to three incision sites covered by a large bandage around your knee after surgery. It's important to keep the bandage and the incision sites clean and dry.

While you can usually shower soon after surgery, you will want to wrap or tape a plastic cover over your knee to keep the wound site from getting wet.

Be sure to contact your surgeon right away if you develop any symptoms or signs of an infection, such as:

• Fever
• Increased redness, swelling, or warmth around the incision site(s)
• Increased knee pain or skin tenderness
• Abnormal drainage from an incision site

A Word From Verywell

The key to a successful ACL surgery is a committed approach to your rehabilitation program. Keep in mind, too, that a longer rehabilitation period doesn't necessarily mean that you are doing anything wrong. The recovery process often varies from patient to patient, depending on factors like the nature or complexity of the injury.

In the end, remain proactive in keeping up with your exercises, and try to find support and encouragement from loved ones and your healthcare team along the way.