Medscape is available in 5 Language Editions – Choose your Edition here.


Rehabilitation for Anterior Cruciate Ligament Injury Follow-up

  • Author: Tarek O Souryal, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
Updated: Mar 01, 2016


See Causes .

In a paper published by Hewett and coauthors, a jump training program was recommended strongly.[24] Another paper, by Wojtys and colleagues, showed that plyometrics and exercises requiring agility, such as running through cones, figure eights, and single leg jumps, are proven methods to improve muscle reaction time significantly.[25]

Ultimately, physical conditioning and balanced knee strengthening (hamstrings as well as quadriceps) are the keys to reducing the risk of an ACL tear.



Complications from ACL surgery generally arise during surgery (see Allograft Reconstruction, ACL-Deficient Knee). Complications include the following:

  • Extravasation of irrigation fluid during arthroscopy
  • Posterior femoral cortex compromise during endoscopic reaming of the femoral tunnel
  • Paresthesias along the lateral aspect of the knee
  • Improper handling of the graft (eg, dropping it on the floor)
  • Bruising and/or hematoma formation
  • Blood loss
  • Improper alignment of the tunnels, causing graft impingement
  • Improper graft placement, making the graft too short and thus not allowing the knee to reach full terminal extension

The main complication of ACL surgery during the postoperative period is rupture of the graft. Careful and conservative physical therapy (PT) during the first 8-12 weeks is important (see Physical Therapy).

Another complication that can develop after surgery is failure to achieve full knee extension (see Physical Therapy).



Most patients achieve good health and mobility after treatment for ACL injury. More than 75% of all patients who undergo ACL repair return to their previous level of functioning. They perform ADL without difficulty and return to participation in their previous sporting or recreational activities.


Patient Education

See the list below:

  • See Physical Therapy.
Contributor Information and Disclosures

Tarek O Souryal, MD Head Team Physician, Dallas Mavericks; Director, Texas Sports Medicine and Orthopaedic Group; Staff, Department of Orthopaedic Surgery, Presbyterian Hospital of Dallas; Clinical Professor, Departments of Orthopedic Surgery and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center

Tarek O Souryal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.


Kenneth Adams, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical School

Kenneth Adams, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

  1. Sanders TL, Maradit Kremers H, Bryan AJ, et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. Am J Sports Med. 2016 Feb 26. [Medline].

  2. Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995 Nov-Dec. 23(6):694-701. [Medline].

  3. Hutchinson MR, Ireland ML. Knee injuries in female athletes. Sports Med. 1995 Apr. 19(4):288-302. [Medline].

  4. Nagano Y, Ida H, Akai M, et al. Biomechanical characteristics of the knee joint in female athletes during tasks associated with anterior cruciate ligament injury. Knee. 2008 Dec 23. [Medline].

  5. Noyes FR, Mooar PA, Matthews DS, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg [Am]. 1983 Feb. 65(2):154-62. [Medline].

  6. Acasuso Diaz M, Collantes Estevez E, Sanchez Guijo P. Joint hyperlaxity and musculoligamentous lesions: study of a population of homogeneous age, sex and physical exertion. Br J Rheumatol. 1993 Feb. 32(2):120-2. [Medline].

  7. Kibler WB, Chandler TJ, Uhl T, et al. A musculoskeletal approach to the preparticipation physical examination. Preventing injury and improving performance. Am J Sports Med. 1989 Jul-Aug. 17(4):525-31. [Medline].

  8. Godshall RW. The predictability of athletic injuries: an eight-year study. J Sports Med. 1975 Jan-Feb. 3(1):50-4. [Medline].

  9. Jackson DW, Jarrett H, Bailey D, et al. Injury prediction in the young athlete: a preliminary report. Am J Sports Med. 1978 Jan-Feb. 6(1):6-14. [Medline].

  10. Shambaugh JP, Klein A, Herbert JH. Structural measures as predictors of injury basketball players. Med Sci Sports Exerc. 1991 May. 23(5):522-7. [Medline].

  11. Souryal TO, Moore HA, Evans JP. Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med. 1988 Sep-Oct. 16(5):449-54. [Medline].

  12. Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study [published erratum appears in Am J Sports Med 1993 Sep-Oct;21(5):723]. Am J Sports Med. 1993 Jul-Aug. 21(4):535-9. [Medline].

  13. Louboutin H, Debarge R, Richou J, et al. Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee. 2008 Dec 19. [Medline].

  14. Beynnon BD, Fleming BC, Johnson RJ, et al. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. 1995 Jan-Feb. 23(1):24-34. [Medline].

  15. Beynnon BD, Uh BS, Johnson RJ, et al. Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med. 2005 Mar. 33(3):347-59. [Medline].

  16. Barker T, Leonard SW, Trawick RH, et al. Modulation of inflammation by vitamin E and C supplementation prior to anterior cruciate ligament surgery. Free Radic Biol Med. 2008 Nov 27. [Medline].

  17. Wu C, Noorani S, Vercillo F, et al. Tension patterns of the anteromedial and posterolateral grafts in a double-bundle anterior cruciate ligament reconstruction. J Orthop Res. 2008 Dec 30. [Medline].

  18. Kim SJ, Jo SB, Kumar P, et al. Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy. 2009 Jan. 25(1):70-7. [Medline].

  19. Muneta T, Sekiya I, Ogiuchi T, et al. Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon. Int Orthop. 1998. 22(6):352-6. [Medline].

  20. Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011 May. 27(5):653-65. [Medline].

  21. Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med. 2012 Mar. 40(3):595-605. [Medline].

  22. Müller U, Krüger-Franke M, Schmidt M, et al. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sports Traumatol Arthrosc. 2014 Sep 2. [Medline].

  23. Villa FD, Ricci M, Perdisa F, et al. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome. Joints. 2015 Oct-Dec. 3 (4):179-85. [Medline]. [Full Text].

  24. Hewett TE, Lindenfeld TN, Riccobene JV, et al. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999 Nov-Dec. 27(6):699-706. [Medline].

  25. Wojtys EM, Huston LJ, Taylor PD, et al. Neuromuscular adaptations in isokinetic, isotonic, and agility training programs. Am J Sports Med. 1996 Mar-Apr. 24(2):187-92. [Medline].

  26. Biedert RM, Bachmann M. [Women's soccer. Injuries, risks, and prevention]. Orthopade. 2005 May. 34(5):448-53. [Medline].

  27. Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med. 2005 Mar. 39(3):127-31. [Medline]. [Full Text].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.