ACL Surgery: Long-Term Care

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Long-term care after anterior cruciate ligament (ACL) surgery involves strengthening your leg with physical therapy and learning how to avoid reinjury.

Benefits of Surgery

Initial management of an ACL tear is focused on reducing pain and swelling with rest, ice, compression, and elevation (R.I.C.E.).

Pre-operative physical therapy is usually started in the week after the initial injury to help restore ACL joint range of motion.

During ACL surgery, the ligament is repaired with a grafted ligament. Intense rehabilitation follows surgery—sometimes for up to a year. Surgery can help an athlete return to their previous level of play in most cases, but there is also a high risk of reinjury.

Runner is protective of knee after ACL surgery
skaman306 / Moment / Getty Images

Possible Future Surgeries

Most people who have ACL injuries repaired surgically return to full activity and sports eight to 12 months after their surgery.

There is a huge risk for re-injury after an ACL repair, though, and the amount of time that passes between surgery and return to full activity seems to be the best protective factor. Research shows that for every month that a return to full play was delayed after surgery, the rate of reinjury was reduced by about 51%. After nine months, however, there is no benefit to further delaying activity beyond nine months after surgery.

In the first two years after ACL reconstruction, about a third of athletes who returned to the same level of play as before their injury tore their ACL in the same or opposite knee. For those who participate in a lower level of play, the reinjury rate is about 8%.

If reinjury occurs, the treatment options are the same as with the earlier injury. Conservative management with physical therapy is an option, but younger athletes who want a return to full play of their desired sport may need to have their ACL surgically repaired again.

Lifestyle Adjustments

As with any surgery, taking care of your physical health will help improve your recovery. With ACL surgery, there are specific things you can do, as well, to prevent re-injury and extend the life of your ACL repair:

  • Use crutches or support braces as directed by your doctor.
  • Participate in any recommended physical therapy or rehabilitation.
  • If you are an athlete, delay your full return to play for nine months.

Delayed return to play can help prevent reinjury and osteoarthritis.

A Word From Verywell

Surgical repair of a torn ACL isn’t the end of the recovery process. Rehabilitation requires long-term physical therapy and a delay in returning to the same level of play for athletes. Make sure to talk to your doctor about your activities, and make a plan together about when it is safe to resume your pre-operative level of activity.

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  1. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-8. doi:10.1136/bjsports-2016-096031

  2. Friedberg RP. Anterior cruciate ligament injury. UpToDate. Updated March 4, 2020.