Physiotherapy After ACL-Reconstruction Surgery

Physiotherapy After ACL-Reconstruction Surgery

ACL Post Reconstruction Rehab:

When an ACL is injured, there are both clinical indicators and subjective instability, necessitating a complete rehabilitation program.  When an ACL ruptures completely and there are clinical and subjective symptoms of instability, surgery is required. Rehabilitation after Anterior Cruciate Ligament Reconstruction (ACLR) is critical to a successful recovery. This rehabilitation procedure lasts six months for the non-athlete group and an athlete needs additional 3 months for sports-specific rehabilitation. The patient should be followed for the entire 6 months to achieve the best possible outcome for a safe return to the same level of activity prior to the accident.


Prior to surgery, rehabilitation should begin. Strength, proprioception, endurance, and gait patterns all suffer after ACL damage. In reality, both the injured and healthy legs experience changes in strength and proprioception. Instability is the predominant symptom of an ACL tear in the knee. This is characterized by ‘giving way’ episodes, which can lead to more joint injury and, eventually, long-term degenerative changes.

A ‘pre-habilitative’ program before surgery should aim towards the following outcomes: full range of motion equal to the opposite knee, minimal joint swelling, enough strength and neuromuscular control, and a positive state of mind.



It is critical to regain and maintain a complete range of motion (ROM) in the knee following ACLR. Obtaining complete knee extension as soon as possible is not harmful to the graft or joint stability and may help reduce patellofemoral discomfort and compensatory gait disorders. It may help to reduce patellofemoral discomfort and compensatory gait disorders.


During the early stages of ACL reconstruction, altered gait kinematics due to quadriceps dysfunction are common. Early weight bearing after ACLR is recommended to restore gait kinematics, enhance vastus medialis function, and reduce the occurrence of anterior knee discomfort.

Treadmill training, particularly inclines or reverse walking, can help to normalize lower extremity ROM across all joints during the intermediate stages of recovery. Walking backward on the treadmill can improve ROM and functional quadriceps strength while reducing patellofemoral stress.


Open and Closed Kinetic Chain Exercises

Subjects’ quadriceps torque increased with the addition of open kinetic chain training without a substantial increase in laxity. Furthermore, open kinetic chain exercises should be performed appropriately and within a specific range to prevent injury to the new graft.


Proprioceptive training should begin early in the rehabilitation phase to establish neuromuscular integration and should continue as proprioceptive abnormalities are discovered beyond 1 year after ACLR. Proprioceptive exercises can improve quadriceps and hamstring strength following ACL Reconstruction.


Gradual return to sport is initiated at 6-9 months if the individual’s knee does not present with discomfort or swelling during or after functional sport-specific training routines.

Return to sport rehabilitation program includes Plyometric training, agility training, Strength & Conditioning, etc.


To sum up, effective recovery after Anterior Cruciate Ligament Reconstruction (ACLR) is essential to regaining knee function and guaranteeing a secure transition back to pre-injury activity levels. Pre-operative care addresses problems with strength, proprioception, endurance, and other aspects of physical health, laying the groundwork for a more seamless recovery following surgery. To establish the best possible surgical environment, a “pre-habilitative” program that emphasizes maximizing range of motion, reducing joint swelling, and improving neuromuscular control is necessary.

Rehabilitation following ACL reconstruction entails essential elements that go into creating a thorough recovery strategy. It is essential to restore and preserve the full range of motion (ROM) in the knee, and early attainment of full knee extension is advantageous for the stability of the joint and the graft. Gait retraining has a key impact, particularly in treating changed kinematics and quadriceps dysfunction during the early stages of recovery.

Muscular strength and endurance training, covering both open and closed kinetic chain activities, are crucial to regaining the strength of the damaged limb without compromising the integrity of the graft. Early neuromuscular integration should be established through neuromuscular and proprioceptive retraining, which should continue for more than a year after ACLR to resolve any residual proprioceptive anomalies.

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