ACL Reconstruction: Post- Operative Visit Objectives

  • Review the operative findings, procedures and photos.
  • Make sure medications are effective and not causing problems.
    • Norco or Percocet (for pain). These excellent pain relievers are a combination of a narcotic plus Tylenol. You may take 1 or 2 tablets every 6 hours as necessary. Our use of local anesthesia during surgery often means patients require reduced amounts of pain medicine. Most patients take narcotic medication for a week or less. You may substitute Tylenol, 1-2 tablets every 6 hours.
  • Wound Care
    • During your first clinic visit we will examine the incisions. The outer bandages may be removed a couple days after surgery. The steri-strips (small, white tape bandages) should be left in place.
    • You may shower 2-3 days after surgery. Water can be allowed to run over the incisions but you should not scrub directly on them.
  • Exercises and Physical Therapy
    • You may begin physical therapy after your first post-op evaluation.
    • Stationary bikes can be helpful to regain motion and strength. Start at 10 minutes with no resistance and slowly increase the time (by 1-2 minutes a day). When you reach 30 minutes you may add resistance every few days.
    • The ultimate goal is to ride continuously for 1 hour per day, 5 days per week with moderate resistance.
  • Crutches
    • You should plan to use crutches for 14 days or more. This rests the knee and you will get better faster overall. Continue to use crutches until you are cleared for full weight bearing.
  • Follow Up appointments
    • Schedule your first post-op visit for approximately 7-10 days after surgery. The next appointment to follow will be at 6 weeks.
  • Notes etc:
    • Make sure you have all necessary notes and documentation for school or work. If you need a temporary parking placard this can be given to you for up to 12 weeks.

For Physical Therapists: Post-Op ACL Repair Rehabilitation

The Principles

  • Stable fixation of the graft allows early exercise and weight bearing within a safe zone. Our goal is to keep the patient safe.
  • Early exercise and weight bearing has been proven to be safe and effective without any decrement in result or graft ligament laxity.
  • It is important to focus on the patient/athlete as a whole. Incorporating all dimensions of performance including aerobic and anaerobic fitness, power, strength, agility and specific athletic function. We must have a clear cut functional objective and develop a program and a strategic plan that realistically allows us to achieve that goal.
  • At all levels, rehabilitation, conditioning and return to sport are a progression. We more specifically describe this as a cyclical progression. This is the formula for safe programmatic progressions.
  • During the program, exercise is essential 6 days a week.
    • Biking – Stationary bike therapy may begin as soon as 24-48 hours after surgery. Start at 10 minutes comfortably then gradually increase time, speed and resistance working towards 1 hour/day by the end of 6 weeks (if you are a professional/elite athlete you will be expected to cycle 2 hours/day).
    • Swimming – This can start as early as 14 days after surgery. The wounds must be completely healed so no water can enter the knee. Freestyle is ideal. Other strokes such as the breaststroke should be avoided due to additional stresses on the knee. Aqua jogging plus water therapy is also excellent.
    • Jogging/Running – This can start at week 8-12 depending on the individual’s progress and the particular surgery performed. The running progression starts with walking with no limp, then walking for 30 minutes with no pain or limp, then walk 5 minutes and jog 5 minutes, then walk 5 minutes and jog ten minutes, then walk 5 minutes and jog 15 minutes and so on.
    • Agility Progressions (The Box)–In general this should be initiated early. The box is set-up with 4 cones 5 yards apart making a box. The box is initially walked slowly, then walked rapidly, then jogged, then sprinted. The box starts at 5 yards then progresses to 10, 20 and 40 yards. Successful execution of this progression allows you to restore agility, propioception and functional return to sports. The following is how the box is to be used:
      • First time around the box – run forward
      • Second time around – side-step left foot forward
      • Third time around – run backward (at manageable pace)
      • Fourth time around – side-step right foot forward


**Please ask about the PEP Program for specifics on this specialized program aimed at strengthening muscles that can help prevent ACL injury and promote enhanced athletic performance. This program is for those patients attempting to return to a high level of athletic activity, with jumping, cutting and pivoting. This program is NOT part of a standard physical therapy rehabilitation protocol.