ACL Reconstruction Rehabilitation

ACL Reconstruction Rehabilitation Protocol

ACL reconstruction surgery takes between 1 hour to 1 1/2 hours to perform.

The next 6 months is very important if the athlete wants to get back to high level sports.

A proper rehabilitation protocol is needed to allow the graft to heal, mature and strengthen while the knee becomes stronger.

The importance of post-ACL reconstruction rehabilitation cannot be over emphasized.



Stage 1 – Pre-surgery physiotherapy

Stage 2 – Week 1 to 2 immediate post-surgery

Stage 3 – Week 2 to 6 Hamstring and Quadriceps Control

Stage 4 – Week 6 to 12 Proprioception

Stage 5 – 3 to 4 months Sports-specific activities

Stage 6 – 5 to 6 months Return to Sports

 Stage 1 – Pre-surgery

Goals Physiotherapy
Reduce pain and swelling Cryotherapy
Achieve full ROM Heel slides
Improve quads strength Isometric quads

 Stage 2 – Week 1 to 2

Goals Physiotherapy
Reduce swelling & Pain ICE, Cryotherapy
Restore ROM: 0 – 90 Heel slides, active/passive knee flexion, prone hangs

Achieve full knee extension

Restore patella mobility Patella mobilisation
Hamstrings and quadriceps muscle control to 4/5 Isometric quads, electical stim on VMO, SLR, hamstring stretches


Watch out for: infection, stiffness, over-stretch graft, bleeding, DVT

Stage 3 – Week 2 to 6 Hamstring & Quadriceps Control

Goals Physiotherapy
Continue to reduce swelling and inflammation Cryotherapy
Increase ROM 0 to 130 Heel slides, active/passive ROM, prone hangs, heel prop
Normal gait pattern in FWB Gait training, pool exercises
Increase hamstring and quads control Quads/hamstrings co-contractions

Hamstring curls

Leg presses, hip strengthening

Step ups/downs

stationary cycling

Mini lunges

Wall squats up to 70 degrees knee flexion

Commence proprioceptive work Static balance exercises, progress to wobble board or balance pad, trampoline


Stage 4 – Week 6 to 12 Proprioception

Goals Physiotherapy
Full ROM Able to sit on heels pain free
Quads strength 85% of non-injured knee Progressive strengthening exercises in gym and poolBegin endurance training
Improved neuromuscular control and proprioception Start threadmill walking – flat and slowly increase to 12 degrees incline

Progress to jogging in straight line

Swiss ball exercises

Swimming – light kick, no breast stroke

Dynamic balance exercises with balance pad, wobble board

Increase hamstring strength Increase weight and repetitions of hamstring curlsCycling on road


Stage 5 – 3 to 4 months, Sports-specific activities

Goals Physiotherapy
Preparation for return to sportImprove skill level Functional sport-specific exercises in controlled situation (no pivoting)
Improve agility and reaction time drills More advanced agility drills (Figure of 8s, start-stops, change directions forwards and backwards, low speed cutting)

Plyometrics – hopping, jumping, skipping

Increase total leg strength and fitness Progress to strength and conditioning programme
Develop patient confidence Isokinetic test


Stage 6 – 5 to 6 months, Return to sports

Goals Physiotherapy
Return to full agilityFunctional test 80% of non-operative legPrioprioception 100% of non-operative leg Increase speed with figure of 8s, sprint stop-start, change surfaces, jumping bilaterally and unilaterally with increase height and surface
Return to Sport Sport specific training – drills with equipment on sport-specific surface

Unrestricted training, match play


For more information, contact us at or call us at +65-683 666 36 or email

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