Physical Therapy After ACL Surgery

After ACL reconstruction surgery, you’ll do physical therapy until you get back to your normal level of activity. For most patients at Shelbourne Knee Center, this takes about four to six months.

Physical therapy focuses on regaining full range of motion, which helps relieve knee pain, and strengthening your knee. You’ll do most of your physical therapy at home, with guidance from your physical therapist or athletic trainer. But you’ll start physical therapy while you’re in the hospital.

Physical Therapy in The Hospital

While you’re in the hospital, you’ll begin your exercises. We’ll show you and your family how to:

  • Use the equipment
  • Do the exercises

We’ll also give you a booklet with the exercises and other instructions.

Knee Exercises

In the hospital, you’ll begin knee exercises.

ACL-reconstructed knee:

  • Extension (straightening):
    • Heel props (perform quad sets at the same time)
    • Prop up opposite leg to make sure extension is equal
    • Towel stretches for full hyperextension (equal to graft leg)
  • Flexion (bending):
    • Use the CPM machine to help with flexion
    • Pull ankle toward the buttocks (using hands) as far as possible
    • Measure flexion by using yardstick (centimeters)

Graft knee:

  • Flexion (bending):
    • Heel slides
    • Measure flexion using yardstick (centimeters)
  • Strengthening:
    • Use the shuttle press

Going home

You can go home the next day if you:

  • Have full extension of the ACL-reconstructed leg equal to the other leg
  • Have flexion of at least 120 degrees on the ACL-reconstructed leg and full flexion on the other leg
  • Can lift both legs with your leg muscles
  • Can walk without help

Before you go home, we’ll give you instructions on home care for the next week and your post-op physical therapy program. You need to understand these instructions before you leave the hospital.

Equipment to Reduce Swelling

After surgery, you’ll wear a Cryo-Cuff® on the ACL-reconstructed knee to prevent swelling, except for when you’re doing your exercises. You’ll use the Cryo-Cuff® as long as your physical therapist or athletic trainer thinks this will help you.

Your leg will also be in a continuous passive motion (CPM) machine. This machine reduces swelling by elevating the knee above the heart. It gently bends and flexes your knee. Most patients use this machine for seven days.

For the first 7 days, you’ll stay in bed with the ACL leg elevated above your heart. When you walk (to the bathroom only), you can put as much weight on the ACL leg as you can tolerate.

Follow-Up Visits After Surgery

You’ll do most of your exercises at home. But you’ll also came back to Shelbourne Knee Center for follow-up visits.

During all visits, you’ll see your physical therapist. He or she will evaluate your strength, range of motion and swelling. Your physical therapist will show you new exercises to do, if you’re ready.

During some visits, you’ll also see your orthopedic surgeon.

Follow-up visits are:

  • 1 week after surgery
  • 2 weeks after surgery
  • 4 weeks after surgery
  • About every 1–3 months after that, depending on how you’re doing

Physical Therapy at Home

We’ll give you a schedule for exercises, using the equipment, and follow-up appointments.

Days 1–7 after surgery

For the first 7 days, you’ll stay in bed with the ACL leg elevated above your heart.

You’ll continue to use your Cryo-Cuff® on the ACL-reconstructed knee and the continuous passive motion (CPM) machine.

Most patients use the continuous passive motion machine for 7 days. Your physical therapist or athletic trainer will tell you how long to use the Cryo-Cuff®.

You’ll do exercises to:

  • Maintain full extension on the ACL-reconstructed leg
  • Maintain at least 120° of flexion on the ACL-reconstructed leg
  • Maintain full flexion on the graft leg
  • Use the shuttle press to work on increasing strength on the graft leg

Follow-up appointment

Your first follow-up appointment will be one week after surgery.

Days 7–14 after surgery

Most patients gradually resume normal daily activities during this week.

You’ll continue your knee exercises. We’ll determine your activity level based on how well your knees are doing.

ACL-reconstructed knee:

  • Use Cryo-Cuff® as needed to decrease swelling
  • Maintain extension:
    • Lock knee straight while standing
    • Heel props
    • Prone hangs
    • Towel stretches
  • Flexion should be at least 135°
    • Heel slides
    • Wall slides
    • Flexion hangs

Graft knee:

  • Maintain full extension and full flexion
  • Increase strength
  • Step-down exercise

Follow-up appointment

Your second follow-up appointment will be two weeks after surgery.

2 to 4 weeks after surgery

You’ll continue your knee exercises. On the ACL knee, you’ll continue working on range of motion:

  • Leg press
  • Knee extension (replaces shuttle)

On the graft knee, you’ll focus on strengthening.

Your physical therapist or athletic trainer will design a customized rehabilitation program for you based on your needs and goals.

Follow-up appointment

Your third follow-up appointment will be 4 weeks after surgery.

2 to 12 months after surgery

You’ll continue physical therapy as you return to your preoperative, fully competitive level of activity.

At each visit, your physical therapist or athletic trainer will evaluate your strength, range of motion and swelling. He or she will advance your therapy and sporting activities based on your strength, comfort and confidence.

Follow-up appointment

During this time, your follow-up appointments will be about every 1–3 months. How often you come in depends on how you’re doing.

Helping Us Improve Care for Other Patients

Our current treatment for ACL injuries is based on our research. We’ve learned what works best by following patients after they finish their rehab.

We hope that you will be part of our research so we can help other patients in the future.

You can do this by taking our annual survey and coming back for free follow-up visits at:

  • 2 years after your surgery
  • 5 years after your surgery
  • 10 years after your surgery
  • 15 years after your surgery
  • 20 years after your surgery