Knee ACL Post op Protocol

Before Surgery

The strength and state of the knee before surgery is vital in ensuring an optimal outcome after ACL surgery. It is important that you have full control of the knee, have good knee balance, a full range of movement and as near normal strength before surgery, which will ensure that you achieve the best possible outcome after surgery. It is important that before surgery, a full range of movement is achieved with minimal or no swelling. It is vital that you have a good chartered physiotherapist looking after you before and after surgery.

Day of Surgery

Mr Kim will apply a long leg stocking (TEDS) to reduce swelling and minimise the risk of thrombosis after surgery. The dressings will be kept for 48 hours; you may apply ice over the dressings. After the dressings are removed, it is important to ice the knee 15-20 min every hour for several hours a day for the 1st 2 weeks in particular. These are to be completed every 2 hours.

Initial exercises include heel slide exercises to increase knee flexion and towel pulls to increase knee extension and flexion. It is particularly important to work on your extension in the 1st few weeks, with extension stretches.

Important to straight leg raise and hold for 20 seconds, repeat this 10 times, 4 times a day for the 1st 4 weeks.

First 2 weeks after surgery

Important to work through your exercises in your exercise sheet every 2 hours. You should keep your TED stockings on for most of the day and night if tolerated to reduce swelling and reduce the risks of clots. You should attend at your physiotherapist within the 1st week of surgery, for massage, and proprioception exercises. You will have crutches to help with your walking. Please weight bear as much as you can tolerate. When resting, keep your leg elevated above the level of your heart with a folded towel underneath your foot and ankle. Keep icing your knee religiously!

From week 2 to 12 weeks post surgery.

Your physiotherapist will monitor your progress carefully at each physiotherapy treatment session. Each patient is different and your rehabilitation goals will be individualised to how well you progress in terms of your own personal goals, motivation, progress in reducing swelling, improving knee range of movement and strength.

It is crucial after the 3 to 4 months after surgery, that neuromuscular factors that predisposed you to injury are addressed to minimise the risk of recurrence of ACL rupture, and to minimise the risk of ACL injury to the other non-involved knee. Many ACL ruptures are non-contact injuries and its important patients realise that there are often muscular factors (constitutional laxity, poor strength, and balance which must be addressed after ACL surgery). Hence it would be many months of rehab and strengthening before you should return to competitive or pivoting sports (football, skiing, etc.) in your other knee.


Before surgery, full range of knee movement and minimal or no swelling in the knee must be achieved with good control of the leg, and good balance. Very important to ice your knee regularly for at least 2-4 weeks to reduce swelling and enable you to do your exercises. Very important to attend and work with your physiotherapist, who will motivate you, monitor your progress, educate, reassure you regarding your progress. There will be ups and downs to endure! My advice: Buy yourself a static bike. Keep it at home; use it regularly, as a routine, to build up your fitness and strength, underpinning the whole recovery process.

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