Physical Therapy After ACL Surgery: Milestones
By Nova Physical Therapy, an outpatient physical therapy clinic in North Hollywood, CA | Published November 2026
Your ACL surgery is scheduled, or maybe you just got home with a brace and crutches. Your surgeon has a rehab protocol, but you want to know what the months ahead really look like. When will you walk normally? Run again? Get back on the court or field?
ACL reconstruction is only the first step. The rehab that follows shapes how well your knee works and how likely you are to get hurt again. This article walks through typical rehab phases and milestones, what research says about returning to sport safely, how physical therapy helps, and which warning signs need your surgeon.
The short answer
Rehab after ACL reconstruction usually lasts about 6 to 10 months (Logerstedt et al., 2017). The APTA guideline recommends starting knee motion within the first week, using electrical muscle stimulation alongside strengthening to rebuild the quadriceps, and using hop tests to check readiness to return to sport (Logerstedt et al., 2017). In a study of 106 athletes, returning to cutting and pivoting sports raised reinjury risk about four times, while waiting until around nine months after surgery and restoring quadriceps strength symmetry lowered it (Grindem et al., 2016; summary). Your surgeon's protocol comes first. In California, you can see a physical therapist without a referral.
What happens in the first few weeks?
Early goals focus on calming the knee and getting it moving. The APTA guideline recommends (Logerstedt et al., 2017):
- Moving the knee within the first week to improve motion and reduce pain
- Cold therapy right after surgery for pain
- Early weight bearing as tolerated, when your surgeon allows
- Electrical muscle stimulation for 6 to 8 weeks alongside strengthening, to help the quadriceps work again
Common early milestones include getting the knee fully straight, bending past 90 degrees, controlling swelling, and walking without crutches when cleared.
What are the main rehab phases?
Every surgeon's protocol is a little different, but rehab often follows these general stages:
- Early recovery: swelling control, full straightening, quadriceps activation, normal walking
- Strength building: progressive leg and hip strengthening, balance, and controlled single-leg work; the guideline recommends starting these exercises within about 4 to 6 weeks (Logerstedt et al., 2017)
- Running and jumping: starting a running progression and landing drills once strength and control allow
- Agility and sport-specific training: cutting, pivoting, and sport drills
- Return to sport: based on testing and your surgeon's clearance, not the calendar alone
When can I return to sports after ACL surgery?
Later than many people hope, and based on testing. In the Delaware-Oslo ACL cohort of 106 athletes, researchers found (Grindem et al., 2016; summary):
- Returning to level I sports (cutting and pivoting sports like soccer and basketball) was linked to a 4.32 times higher reinjury rate
- Waiting until about nine months after surgery was linked to a lower reinjury rate
- More equal quadriceps strength between legs before returning was linked to fewer reinjuries
The study's title sums it up: simple return-to-sport decision rules can reduce reinjury risk substantially. The APTA guideline recommends single-leg hop tests to check side-to-side differences and track readiness (Logerstedt et al., 2017).
How can physical therapy help?
A physical therapy evaluation after ACL surgery may include:
- Your surgeon's protocol, restrictions, and the type of graft
- Swelling, knee motion, and walking
- Quadriceps, hamstring, and hip strength, compared side to side
- Balance, landing, and hop testing when ready
- Screening for complications that need your surgeon
A typical plan may include:
- Early motion, swelling control, and quadriceps activation
- Electrical muscle stimulation with strengthening
- Progressive strength, balance, and movement control training
- Running, jumping, and agility progressions
- Return-to-sport testing and a plan to lower reinjury risk
Physical therapy doesn't guarantee a specific result or timeline. Your surgeon's protocol and clearance guide each stage. At Nova Physical Therapy in North Hollywood, rehab after knee surgery and sports injury rehab are among our core services, and every plan starts with an evaluation so treatment fits what we find. For more on ACL injuries, read our post on ACL tears and rehab before surgery.
When should I call my surgeon?
Call your surgeon promptly or get urgent care if you have:
- Fever, chills, or redness, warmth, or drainage at the incision
- Calf pain, swelling, warmth, or redness, which could be a blood clot
- Sudden shortness of breath or chest pain (call 911)
- A sudden increase in swelling or pain, or a new pop
- Numbness or tingling in the foot that's getting worse
- Losing knee motion you had already gained
We screen for these signs during every visit and contact your surgeon or refer you for medical care when findings call for it.
Do I need a referral for physical therapy in California?
Not to get started. California allows direct access to physical therapy. A physical therapist can evaluate and treat you without a referral for up to 45 calendar days or 12 visits, whichever comes first. After that, a physician or podiatrist needs to sign the plan of care for treatment to continue. Your insurance plan may have its own referral rules, so check your coverage or see our insurance page.
Frequently asked questions
How long is rehab after ACL surgery?
Usually about 6 to 10 months, depending on your knee, your goals, and your surgeon's protocol.
When can I walk normally after ACL surgery?
Many people walk without crutches within the first few weeks, once swelling is controlled and the surgeon allows. It varies with the graft and any other repairs.
When can I run after ACL surgery?
Running usually starts a few months after surgery, once strength, motion, and control meet your surgeon's and therapist's criteria.
When can I return to sports after ACL reconstruction?
Often around nine months or later, based on strength and hop testing and your surgeon's clearance. Returning earlier has been linked to higher reinjury risk.
Why is quadriceps strength so important after ACL surgery?
The quadriceps often weaken after surgery. Restoring strength close to the other leg is linked to fewer reinjuries and better knee function.
Should I start physical therapy before ACL surgery?
Usually, yes. Reducing swelling and restoring motion and strength before surgery often makes recovery afterward smoother.
Do I need a referral to see a physical therapist?
No, not to start. California allows direct access within the limits described above. After surgery, we follow your surgeon's protocol.
About Nova Physical Therapy
Nova Physical Therapy is an outpatient physical therapy clinic in North Hollywood, California, led by a Doctor of Physical Therapy. We help people recover from sports injuries, back and neck pain, work injuries, auto accident injuries, knee pain, and shoulder problems, and we also work with balance problems and rehab after surgery. Patients come to us from North Hollywood, Burbank, Studio City, Toluca Lake, Valley Village, and across the San Fernando Valley. Learn more about Nova or see our services.
Schedule an evaluation
If you’re preparing for or recovering from ACL surgery, an evaluation can help you start rehab and build a step-by-step plan back to your sport.
Nova Physical Therapy
4795 Vineland Ave #E, North Hollywood, CA 91602
Call (818) 639-3402 | Book an appointment online
Disclaimer
This article is for general education only. It is not medical advice, a diagnosis, or a treatment recommendation for any individual. Recovery after surgery varies, and your surgeon’s protocol guides your rehab. Only an in-person evaluation can determine what is right for you. No treatment guarantees symptom resolution, and results vary. Physical therapists evaluate movement and function within their scope of practice and refer to physicians when findings warrant. Physical therapy in California is regulated by the Physical Therapy Board of California.
References
- Logerstedt DS, et al. Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain Revision 2017. J Orthop Sports Phys Ther. 2017;47(11):A1–A47. Link
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–808. Link
- Becker’s Spine Review. What reduces re-injury rate after ACL reconstruction? 4 observations. Link