Rehabilitation after ACL reconstruction takes place in stages, and moving on to the next one depends on criteria, not the calendar: first controlling swelling and getting the knee fully straight, then rebuilding quadriceps strength, balance training, running and jumping, and finally return-to-sport tests. In studies, returning to competitive sport before the 9th month was linked with a clearly higher risk of re-injury.
Below we describe the symptoms that mean you should contact a doctor first, the successive stages of rehabilitation, 3 general exercises to start with, the criteria for returning to sport and the most common mistakes. The pace of treatment is always set by the surgeon and the physiotherapist.
In brief
- The stages of rehabilitation are set by criteria (straightening, swelling, strength, movement control), not by the number of weeks since surgery.
- According to the Delaware–Oslo cohort study, returning to competitive sport before the 9th month was linked with an approximately 7 times higher risk of re-injury.
- A physiotherapy consultation costs PLN 180, manual therapy PLN 180.
- Home physiotherapy within 15 km of Rydułtowy: approximately PLN 200 for up to 5 km, then + PLN 2/km; we agree the exact price when booking.
- The clinic is open Mon–Fri 7:00–20:00, private visits only (not covered by NFZ, the Polish public health fund).
Contents
What does rehabilitation after ACL reconstruction involve?
Rehabilitation after reconstruction of the anterior cruciate ligament (ACL) is a gradual exercise programme designed to restore full knee movement, strength in the thigh and hip muscles, and control of movement when changing direction and landing. It usually starts in hospital, and its course depends on the type of graft, any additional procedures, e.g. meniscus repair, and the surgeon’s recommendations.
The graft needs time to heal and remodel, so the programme combines protecting the knee with gradually increasing load. At each visit the physiotherapist checks swelling, range of movement, strength and the way you walk, and then chooses exercises for the next period. For one person a stage is shorter, for another longer – which is why we do not give a fixed schedule.
When should you see a doctor first after ACL reconstruction?
Contact a doctor or the hospital urgently if the wound is red, hot or leaking fluid, if you have a fever, if the swelling and pain in the knee are clearly increasing instead of decreasing, if you have pain, swelling and warmth in the calf, breathlessness or chest pain, and also after a new injury with a feeling of the knee “giving way”.
Pain and swelling in the calf may indicate deep vein thrombosis, and sudden breathlessness a pulmonary embolism; in this situation call 112. The knee locking, or a loss of straightening that does not improve despite exercise, also requires a medical consultation.
What are the stages of rehabilitation after ACL surgery?
Four stages are most often distinguished: protecting the knee and regaining straightening, rebuilding strength and normal walking, neuromuscular training with running and jumping, and preparation for sport. Each ends when criteria are met, e.g. full straightening without swelling, or strength in the operated leg close to that of the healthy one. The decision to move on is made by the physiotherapist in consultation with the doctor.
- Protection and straightening. Reducing swelling (cooling, raising the leg), regaining full straightening and activating the quadriceps. Walking with crutches as recommended by the doctor.
- Strength and walking. Gradually increasing knee bending, closed-chain exercises (e.g. half squats), a stationary bike, learning to walk without limping and without crutches.
- Movement control. Single-leg balance exercises, working on keeping the knee aligned over the foot, and once the criteria are met – jogging and learning to land.
- Preparation for sport. Changes of direction, jumps, sport-specific elements, and finally strength tests and hop tests.
Which exercises are done at the start?
At the start, simple exercises are usually used to activate the quadriceps, improve circulation and restore knee movement. Do them only if the surgeon or physiotherapist has recommended them, because after meniscus repair or other additional procedures the restrictions may be different. The 3 exercises below are general and do not replace an individual programme.
- Ankle pumps. Lying with your leg raised on a pillow, bend and straighten your foot at the ankle. 2–3 sets of 15–20 movements, several times a day.
- Quadriceps tightening. Lying with your leg straight, press the back of your knee down into the surface (you can place a rolled-up towel under your heel) and hold. 10 repetitions of 5 seconds, 3 times a day.
- Heel slides. Lying on your back, slowly slide your heel along the surface towards your buttock within the range allowed by the doctor, and return to straight. 2 sets of 10 repetitions, 2–3 times a day.
If the pain gets worse or spreads, stop the exercise and consult a physiotherapist.
When can you return to sport after ACL reconstruction?
You return to sport once you meet the criteria, not after a set amount of time. They usually include full, pain-free knee movement, no swelling, muscle strength in the operated leg at about 90% of the healthy side, normal hop test results and psychological readiness. In studies, people who met such criteria were less likely to suffer a re-injury.
In the Delaware–Oslo cohort, each month of delay in returning to competitive sport, up to the 9th month after surgery, reduced the risk of re-injury, and meeting the strength criteria lowered it further. Final approval to return to sports involving pivoting and contact is given by the doctor. We describe other knee injuries in our guide joint pain and injuries.
How does a physiotherapist help, and can rehabilitation take place at home?
The physiotherapist leads the exercises, assesses progress against criteria, teaches walking and movement control, and uses manual therapy and kneecap mobilisation when movement is limited. In the first period after surgery, when travelling is difficult, rehabilitation can take place in the patient’s home. The “W zdrowym ciele” clinic travels within 15 km of Rydułtowy, including to Rybnik and Wodzisław Śląski.
Later, visits to the clinic are usually more beneficial, as it is easier to carry out strength and balance training there. The physiotherapist decides on the type of treatment and the number of visits individually after the consultation, taking the surgeon’s recommendations into account.
Home physiotherapyin the first period after surgery, when getting to the clinic is difficultapproximately PLN 200 for up to 5 km, then + PLN 2/km; we agree the exact price when bookingManual therapyfor limited knee bending or straightening and a stiff kneecap180 PLNPrices valid from 08.2026. We write more about this method in our article manual therapy – what it involves.
What are the most common mistakes after ACL reconstruction?
The most common mistakes are: neglecting straightening exercises in the first period, giving up crutches too early while still limping, rushing into running and jumping while the knee is still swelling, comparing yourself with other patients, and returning to sport just because “a lot of time has passed”. Each of these can delay recovery or increase the risk of injury.
Lost full straightening is hard to regain later, which is why physiotherapists pay close attention to it from the first days. Swelling after training is a sign that the load was too great and needs to be reduced.
Good to know: for your first visit, bring your hospital discharge summary, the operation report (type of graft, meniscus procedures) and the doctor’s recommendations on weight-bearing and the brace.
Summary
Rehabilitation after ACL reconstruction moves from protecting the knee and straightening, through strength and walking, to movement training and sport, and the pace is set by criteria and the doctor’s recommendations. A consultation in Rydułtowy costs PLN 180, and in the first period home physiotherapy is available within 15 km of the clinic.
Frequently asked questions
How many physiotherapy visits are needed after ACL reconstruction?
The physiotherapist decides on the number of visits individually after the consultation, because it depends on the type of surgery, any additional procedures, your starting fitness and your goal, e.g. returning to football. Regular exercise at home also matters. Progress is assessed against criteria at each visit, and the plan changes accordingly.
Is it worth exercising before ACL surgery?
Yes, preparation before surgery, known as prehabilitation, is recommended. Its aim is to reduce swelling, regain full knee straightening and as much quadriceps strength as possible. In studies, a better knee condition before surgery was linked with better results after the operation. It is worth agreeing the range of exercises with a physiotherapist and a doctor.
Do I need to wear a knee brace after ACL reconstruction?
This depends on the surgeon’s decision. Some centres recommend a brace in the first period, especially after meniscus repair or other additional procedures, while others do without one. Whether to wear it, for how long and how to set the range of bending is decided by the doctor. The physiotherapist follows these recommendations.
When can I drive after ACL surgery?
A doctor decides when you can return to driving. What matters is which leg was operated on, the type of gearbox, the painkillers you are taking and your ability to brake quickly and firmly. Before your first drive, it is worth checking with a physiotherapist whether the strength and movement of your knee allow you to use the pedals safely.
Do I need a referral for rehabilitation after ACL surgery?
For a private visit at the “W zdrowym ciele” clinic a referral is usually not required. The clinic has no contract with the NFZ (the Polish public health fund), and a consultation costs PLN 180. Because of the nature of the surgery, however, the physiotherapist relies on the surgeon’s recommendations, so it is worth bringing your discharge summary and the operation report.
Can the knee keep swelling for a long time after ACL reconstruction?
Occasional swelling after greater effort is common in the first months after surgery and usually indicates too much load. The physiotherapist then reduces the intensity of the exercises. However, swelling that increases for no clear reason, or comes with fever, redness or the knee locking, requires an urgent consultation with a doctor.
Sources
- Grindem H. et al., Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study, British Journal of Sports Medicine, 2016.
- van Melick N. et al., Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus, British Journal of Sports Medicine, 2016.
- Ardern C.L. et al., 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern, British Journal of Sports Medicine, 2016.
About the author: Tatiana Grabowska, MSc – master’s degree in physiotherapy, licence to practise number PWZFz 11646 (Polish licence to practise as a physiotherapist). Since 2013 she has run the “W zdrowym ciele” physiotherapy and rehabilitation clinic in Rydułtowy; she has about 12 years of professional experience. Physiotherapist’s profile
- Consultation180 PLN
- Referralnot needed
- ReceptionMon–Fri: 7.00–20.00
