ACL Rehab Protocol: Step-by-Step Guide to Recovery
Discover the structured ACL rehab protocol to help you recover safely and effectively after surgery.
After an Anterior Cruciate Ligament (ACL) surgery, the quality of the ACL protocol for rehab plays an important role in the successful recovery of the knee and the patient.
Why Follow an ACL Rehab Protocol?
Following a clear ACL rehab protocol after your operation makes all the difference. Surgery is just one step; the real progress comes through a well-structured plan of rehab exercises for ACL recovery.
This rehab protocol is designed to:
- Prevent early complications: pain, swelling, haemarthrosis (bleeding into the joint space)
- Restore mobility, especially full extension
- Rebuild stabilising muscle strength (quadriceps, hamstrings, glutes)
- Correct walking patterns and regain natural movement
- Safely prepare for a return to sports with confidence
Professor Cavaignac is proposing a progressive, criteria-based ACL rupture rehab protocol in collaboration with the physiotherapists at SPS Therapy: Benoit Hennart, Maxime Testory, Maxime Ourliac, Kévin Lacaze. This program adapts to all activity levels, whether you are an athlete or not, and tailors the intensity and progression to your specific needs.
The torn ACL rehab time is divided into five key phases, each with clinical benchmarks to ensure safe progression..
ACL Rehab Timeline: A Structured, Criteria-Based Progression
This ACL rehab timeline follows a strict methodology: you only progress to the next phase when the current one is successfully completed. Exercises are introduced based on readiness, not on fixed timelines alone.
Each stage of this ACL tear rehab program is guided by clinical tests (e.g. knee extension, quadriceps strength, joint swelling). This ensures safety, builds trust in your recovery and provides a personalised approach for every patient.
ACL Rehab Exercises: The 5 Recovery Phases
Each phase of the protocol targets a specific stage of healing, with ACL rehab exercises designed to meet the functional needs of your knee as it recovers.
Phase 1, Days 0–10: Laying the Foundations
Start your ACL post-op rehab protocol with safe and targeted movements, guided by our instructional videos.
Goals
Reduce inflammation, protect the knee, achieve full extension.
Recommended Actions
- No brace; use two crutches from day one
- Ice: 20 minutes, 3x daily
- Gentle mobility exercises: seated or lying heel slides
- Active locking: quadriceps contraction (3x/day, 10 min)
- Hip strengthening: unloaded movements
- Education: stairs, posture, self-massage
Note
Do not force flexion in this phase, the risk of haemarthrosis is high. In this phase of the ACL repair rehab protocol, it is important to prioritise full extension.
Requirements to proceed to Phase 2
- Extension at 0
- AMI grade 0 or 1A
- Stroke Test 0 or 1
- No hematoma
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See instructionsPhase 2, Days 10–30: Regaining Confidence and Movement
Move into more dynamic exercises for ACL rehab, rebuilding muscle and mobility.
Goals
Improve flexion, walk naturally, begin muscle strengthening.
Recommendations
- Begin walking without crutches (if knee is dry and fully extended)
- Use a stationary bike (no resistance) to improve flexion
- Controlled leg press at 50% body weight (6 seconds up/down)
- Gait training with hurdles, backwards treadmill walking
- Standing quadriceps exercises with elastic resistance
Note
Focus on active locking: consciously keeping the knee straight and stable in weight-bearing.
Requirements to proceed to Phase 3
- Full Extension
- AMI grade 0
- Stroke Test 0
- Flexion +120°
- Positive Quadriceps Lag test
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Phase 3, 1–3 Month: Strength and Coordination
Build strength and control with targeted ACL rehab exercises for phase 3: a critical phase of your protocol.
Goals
Achieve 90% flexion, increase strength, improve motor patterns.
Recommendations
- Split squats with correct hip-knee-foot alignment
- Glute bridges and unilateral versions
- Functional balance exercises on one leg
- Introduction to light weights (goblet squats, resistance bands)
Note
At this stage, quality matters more than quantity. Controlled, well-executed movements will prevent reinjury and improve long-term outcomes.
Requirements to proceed to Phase 4
- Good quality single-leg squat
- Single-leg Bridge 85% of contralateral
- Single-leg Calf raise 85% of contralateral
- Single-leg Raise 85% of contralateral
- Side Bridge Endurance 85% of contralateral
- Leg Press 1.5x Bodyweight
- Quadriceps Dynamometer (1.45 N/kg)
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Phase 4, 3–5 Months: Running and Plyometrics
This phase of your ACL surgery rehab time introduces dynamic movements and prepares your knee for return-to-run protocols.
Goals
Resume running and reinforce motor control.
Recommendations
- Gradual return-to-run programme (e.g. from “La Clinique du Coureur”)
- Advanced single-leg drills: walking lunges, Nordic hamstrings
- Introduction to low-level plyometrics: jumps, landings, movement control
Note
Though training intensity increases, technical form must remain a top priority.
For instance, in a single-leg squat, avoid inward knee collapse (dynamic valgus) and maintain a straight spine. A misaligned knee can strain internal ligaments and slow recovery; a rounded back compromises force transmission and raises lumbar stress.
Requirements to proceed to Phase 5
- Completion of a structured running program
- Single-Leg Hop Test: ≥ 90% of contralateral limb
- Single-Leg Triple Hop Test: ≥ 90% of contralateral limb
- Single-Leg Crossover Hop Test: ≥ 90% of contralateral limb
- Side Hop Test: ≥ 90% of contralateral limb
- Leg Press: ≥ 1.5 × bodyweight
- Clearance from surgeon, physician, or rehabilitation specialist
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Phase 5, After 6 Months: Return to Sport
Final stage of your ACL rehab protocol: return to sport and prepare for sport-specific performance.
Goals
Secure and validated return to sport or competition.
Recommendations
- Functional testing: single leg hop, triple hop, crossover hop (≥90% symmetry)
- Sport-specific drills: jumps, pivots, decelerations
- Collaboration with coach or trainer
- Mandatory medical clearance before competition
Note
Rehab of ACL injury goes beyond pain relief, this protocol ensures your knee can withstand high-level performance.
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Monitor Your ACL surgery rehab protocol with Orthense
Every stage of this ACL surgery rehab protocol is guided by clear criteria: full extension, muscle strength, no swelling. To track your post-op ACL rehab protocol, Professor Cavaignac uses Orthense, a digital health platform that provides:
- Exercise video access
- Follow-up questionnaires
- Reminders and individualised guidance
This system ensures consistent, safe and confident recovery.
ACL Surgery Rehab Time Requires Structure, Not Guesswork
Recovering from an ACL rupture rehab is not about improvising exercises. It’s about following a defined plan, personalised to your progress. Thanks to this structured and expert-led ACL rehab protocol (PDF and video content available), you will regain confidence, autonomy, and full function at your own pace and with optimal safety.
Planning an ACL Surgery?
Your post-operative care is key. Professor Etienne Cavaignac offers an expert ACL reconstruction rehab protocol using digital tools and personalised guidance, to give you the best possible outcome after your surgery.