Preparing for ACL Surgery? Here’s What You Need to Know

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If you’re scheduled for Anterior Cruciate Ligament (ACL) reconstruction surgery, understanding what to expect can help you feel more confident and prepared. This guide outlines your pre-surgery preparation, post-surgery milestones, and how physiotherapy plays a crucial role in your recovery.

Recovery is based on meeting specific rehabilitation criteria, not just time alone. A structured rehab plan, guided by your physiotherapist, will ensure the best possible outcome.

✅ Regain full knee extension (ability to fully straighten the leg)
✅ Reduce swelling and inflammation
✅ Improve quadriceps strength (especially for straight leg raises)
✅ Work on balance and stability
✅ Walk with a normal gait pattern (without limping)

We recommend at least 1-2 physiotherapy sessions before surgery to optimise your recovery and improve surgical outcomes.

Your ACL recovery will progress through phases, with each phase based on functional goals rather than a specific time frame but we have give typical time frames as a guide.

Goals:

✅ Control pain and swelling (ice, elevation, compression)
✅ Achieve full knee extension (straightening)
✅ Bend the knee to at least 90 degrees
✅ Begin quadriceps activation (avoid muscle loss)
✅ Walk with crutches as needed

Recommended Physiotherapy Appointments:
➡️ 1-2 sessions per week to manage pain, swelling, and early movement.

Goals:

✅ Full knee extension & flexion >120°
✅ Reduced swelling (trace or zero on swelling test)
✅ Walking without crutches and normal gait
✅ Quadriceps strength ≥60% of uninjured leg

Recommended Physiotherapy Appointments:
➡️ 1 session per week to progress mobility and strength.

Goals:

✅ Full knee range of motion
✅ Quadriceps strength ≥70% of uninjured leg
✅ Single-leg squat with good control
✅ Jogging may begin (only if criteria are met)

Recommended Physiotherapy Appointments:
➡️ Every 1-2 weeks to monitor strength and prepare for jogging progression.

🚨 Running is based on strength and control—not just time.

Goals:

✅ Quadriceps strength ≥85% of uninjured leg
✅ Hop tests ≥90% limb symmetry
✅ Controlled change of direction movements
✅ Pain-free jogging, progressing to sprinting

Recommended Physiotherapy Appointments:
➡️ Every 2-4 weeks to refine movement patterns and build agility.

Goals:

✅ Quadriceps strength ≥90% of uninjured leg
✅ Hop tests ≥95% symmetry
✅ Full running, cutting, and jumping without pain
✅ Psychological readiness for sport

Return-to-Sport Criteria:

• Passes strength and agility tests
• No pain or swelling after high-impact activities
• No fear of re-injury (ACL-RSI score >56)

Recommended Physiotherapy Appointments:
➡️ Every 4-6 weeks until return to full activity

Important: Returning to sport too early increases the risk of re-injury. A structured return-to-play plan will be developed with your physiotherapist.

ACL rehabilitation should be personalised to your needs and progresses based on functional milestones, not just time. Here is a rough guide to the commitment and investment you need to make towards a successful recovery. 

📅 Recommended Appointment Frequency:

Pre-Surgery: 1-2 sessions to optimise strength and movement
0-6 Weeks Post-Op: 1-2 sessions per week to control pain and swelling
6-12 Weeks Post-Op: Every 1-2 weeks to rebuild strength
3-6 Months Post-Op: Every 2-4 weeks to progress running and agility
6-9+ Months Post-Op: Every 4-6 weeks until full return to activity

Everyone’s recovery is different, and our physiotherapists are here to guide you through every step of the process.