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What Comes Next After ACL Surgery?

Updated: Jun 6, 2023

You recently had ACL surgery and you might be asking yourself: what comes next? What does my recovery look like now? When do I get to run again?

These are all great questions and ones I’m going to answer in this month’s blog as a follow-up to Dr. Jason Wilcox’s blog earlier this month on ACL surgeries.

physician evaluating a patient's knee

ACL Surgery Recovery Process

Ok, so you’ve recently had ACL surgery and you are ready to start some physical therapy! Following each surgery, there are small nuances during each person’s recovery, but with ACL surgeries becoming so common nowadays the overall recovery process pretty much stays the same.

Following your surgery, your surgeon will determine if bracing or crutches are important for you to utilize. Crutch use can last anywhere from a week to two, while brace wearing can last up to a month. The overall goal, though, is to regain your normal walking pattern as soon as possible if your doctor has prescribed a brace and crutches, just a brace, or no brace and crutches. This is important as it will help you regain leg strength and most importantly your independence.

The next most central item during your recovery process is to regain the knee's range of motion. During the first two weeks of recovery, you try to regain full knee extension and 90 degrees of knee flexion. During the first two weeks, you do not try to push past that initial 90 degrees of knee flexion as the graft is strengthening and stabilizing within the knee joint. Pushing too far past 90 degrees of knee flexion initially could increase the risk of stretching the graft and result in a less stable graft. Following these initial two weeks, the objective is to continue to regain full knee extension while progressing toward 120 degrees of knee flexion. At the end of the month, the process going forward is to regain full knee motion both in flexion and extension making it symmetrical to the non-surgical side.

While regaining the knee's range of motion it is also imperative to recover muscle strength that was lost during the surgical process. Many people ask me why they lose so much muscle strength and control during surgery. The answer to that question has a few components. The main ones are swelling following the surgery, surgical leg disuse as a result of pain and swelling, and the surgical process itself all playing a factor in reducing your muscle strength and function in the surgical leg.

Blood Flow Restriction Training for ACL Recovery

At Rehab United Seattle our goal is to help you recover the lost strength following surgery as quickly as possible. To help you achieve this we utilize a technique called Blood Flow Restriction Training (BFRT). According to research on BFRT following ACL surgery, it has been found to increase muscle strength faster, and reduce recovery time when used consistently during the first three months of a person’s ACL recovery process compared to non-BFRT-utilizing patients. You might be asking yourself what is BFRT? Great question! BFRT is a technique we employ to create an artificial high-intensity environment for your leg to work in as you progress back to more traditional loading during the strength training portion of your recovery. The artificial environment we create by using the BFR cuff will send a stimulus to your body to help with tissue, tendon, and muscle growth, as well as help reduce swelling in the knee joint that has occurred.

After three months of working on regaining full knee range motion, building strength in the surgical leg with BFR training, and traditional strength training, you are now allowed to return to running and jumping activities. As you can imagine following a three-plus month layoff from these activities you will not be able to jump right back into your previous fitness routine. At Rehab United Seattle, we have both a return to run and jump protocol that culminates in you running 30 consecutive minutes and doing box jumps. This all happens over month three and four of your recovery process. At the end of month four, most patients will discharge to a home exercise program, some may need another month or two, it all really just depends on you and your recovery process. The overall goal though is by month six you’ve fully returned to all of your previous activities.

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