Rehabilitation after ACL Reconstruction

The bottom line:
Sticking to rehab plan is equally important as is a good surgical procedure !

Congratulations ! It’s time to start working hard and recovering after your surgery. Your recovery plan will be customized to you and the specifics of your knee, surgery, and future plans. Please use the information on this page as a guideline but not the rule. Be sure to ask questions anytime.

Why a progressive ACL rehab plan?

Recovery after ACL surgery has several stages. First, get over having an operation and get the flexibility back into your knee. Next, let the graft heal into place. Finally, regain strength, endurance and agility. Simple right ?

Each stage may vary in duration for you compared with the next athlete. Different strength requirements, graft considerations, and demands on your knee will guide the overall plan.

Phase 1: Surgical recovery and flexibility

Week 1-6
ACL RehabTherapy will start within 24-72 hrs of surgery. Start working on your range of motion. This will come slowly. Get your leg straight within the first 2 weeks. Mobilize the patella and soft tissues around the knee to help prevent scarring. Use the knee brace and crutches. In many cases, you will be limited weight bearing during this entire phase. Trying to go all the way around on the stationery bike is helpful.


Aspirin: I typically suggest 81mg of aspirin for the first 10 days to decrease the risk of blood clots. Symptoms to watch for are worsening calf pain, or leg swelling that seems unrelated to the swelling from the surgery. Let me know right away about this. I’ll send you for a simple painless ultrasound of the leg to check.

Ibuprofen: This medicine helps with pain and inflammation. It works in your knee. I typically will suggest 600-800mg three times a day unless it bothers your stomach. This will help reduce swelling, inflammation and pain.

Vicodin / Percocet: A strong narcotic. This does nothing for your knee, but tells your brain you don’t have pain. You are not required to take this, but may use it as needed. If it is not working, call me right away. You will not get addicted to a medication if taken for the right reasons.


Ice your knee for about 20 minutes on, then give it a break for another 20-30 minutes. You can do this throughout the day to help keep the swelling to a minimum. Never put ice directly on your skin – it can give you frostbite. This is especially true if you have an ‘ice machine’ as they get extremely cold. Always keep a layer of material between you and the cold pad.


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Leave the dressing in place until the 2nd day after surgery. On day 2, remove the ACE wrap, cotton wrap, gauze and non-stick dressing on the knee. Leave the steri-strips in place – these are used as the stitches. Don’t remove them. Recover your incisions with gauze and the ACE wrap.


You may shower, but keep the wounds covered until I see you back in the office in 7-10 days. After that visit, and if given the green light, you may get the wounds wet in the shower. No hot tubs, spas, bathtubs, or time in the ocean until the wounds are completely healed – usually by week 3.

Phase 2: Start light strengthening, but go slow

Week 6-12
While your knee will often feel great at this point, the graft is still not healed and your muscles are still very weak. Trying to do too much could led to reinjury. By now, the brace will be off, and you will be full weight bearing without restriction. You should still stay away from the ocean, beach, or hiking on uneven surfaces.

Physical therapy will continue, perhaps less frequently if you are motivated and can do your exercises on your own. Progress will start to come slower. Your quadriceps muscles are still quite weak. Work on your strength. This should include core, quads, hamstrings, and calf muscles. Riding the stationary bike should be done for range of motion as well as light strength and cardio.

Phase 3: Strength and agility

Week 12-36
ACL Rehab 2Strength will continue to come and your muscles may start to look normal again now. Your physical therapist will still track you through this phase to gain strength and endurance. As the strength comes, we will start working on agility = your quickness to react. This should be exciting to see the progress. You are almost ready to get going again !

Goals to know you are ready:

Never return to sports unless I have cleared you to do it.
Thigh circumference within 1-2cm of the normal side.
Able to tolerate a sport test.

If you have general questions about the immediate recovery after ACL reconstruction, you can contact me through Ask Dr. Hacker. If you need immediate assistance, check out my contact information here.