ACL rehabilitation after anterior cruciate ligament reconstruction is phased from early post surgery to return to normal function, including sport.
Page updated August 2023 by Dr Sheila Strover (Clinical Editor)
Phases of ACL rehabilitation
ACL rehabilitation takes into account the initial period when the new ligament is gaining a blood supply, then the period of improving range of motion and strength, then the final stage of return to full activities.
Recognising complications during ACL rehabilitation
If there is a failure to make progress with extension during ACL rehabilitation, one must think of the potential complications of notch impingement and cyclops lesion. Notch impingement is when the intercondylar notch has not be sufficiently widened to allow easy mobility of the graft during flexion and extension. If the graft keeps catching, it may start to strip a little with each passage and the stripped tissue can bunch up into a cyclops lesion, where a scarred lump can catch on the roof of the notch with each extension.
- Robs ACL Allograft Exercise Journal with Timeline
A comprehensive explanation of a patient's rehabilitation regime, with discussion.
- Calf Pain after ACL Reconstruction (hamstring graft)
Early-onset calf pain after hamstrings graft for ACL.
"Clinicians should be discouraged not to use strict time frames and protocols .... guidelines should be followed that allow the rehabilitation specialists to progress the patient as improvements in strength, edema, proprioception, pain, and range of motion are demonstrated. Prior to returning to sport, specific objective quantitative and qualitative criteria should be met."
Citation: Cavanaugh JT, Powers M. ACL Rehabilitation Progression: Where Are We Now? Curr Rev Musculoskelet Med. 2017 Sep;10(3):289-296. doi: 10.1007/s12178-017-9426-3. PMID: 28791612; PMCID: PMC5577427.
Relevant material -
From other Experts -
- Course - ACL reconstruction failure and revisions - by Dr Frank Noyes (Knee Surgeon)
- General articles - ACL injuries in female athletes - by Ms Michelle Boucher (Clinical Editor)
- Journal interpretation - 2018 - Should return to sport be delayed until two years after anterior cruciate ligament reconstruction? Biological and functional considerations - Peer-reviewed publication by Nagelli CV and Hewett TE, 'interpreted' by Dr Sheila Strover (Clinical Editor)