Part of ACL reconstruction rehab

ACL prehab exercises: what to do in the weeks before surgery

ACL prehab exercises have three jobs, and they are the same three the first weeks after your operation will have: get the swelling down, get the knee straightening as fully as the other one, and get the thigh muscle switching on again. The van Melick guideline recommends a rehab phase before an ACL reconstruction, so prehab is standard practice rather than something extra you have talked yourself into. What it is not is a guaranteed shortcut. A systematic review of randomized trials on this found three trials, all at high risk of bias, with a small benefit for quadriceps strength in one trial and single leg hop scores in two, measured 3 months after surgery, and rated the evidence as very low quality (Carter and colleagues, 2020). So the honest version is that prehab is low risk, is what most teams ask for, and may help a little with the things it trains, and nobody can promise you weeks off the far end. The exercises are usually the same early ones the program uses afterward: ankle pumps, quad sets, a heel prop to work on straightening, heel slides inside whatever range you are given, a straight leg raise once the knee stays straight, then bridges, mini squats and calf raises if your knee tolerates them. If your knee is still locking, giving way or swelling up within hours of ordinary movement, do not load it on the strength of this page. Get it looked at first, and the warning signs below say how fast.

Warning signs, and when to get help

What is ACL prehab for?

Three things, and the order matters, because people spend the wait on the wrong one.

Swelling first. A swollen knee will not straighten and will not let the thigh muscle switch on properly, so everything else waits behind it. Straightening second: full extension, matching the other leg, which is also the first aim of the program after the operation. The thigh muscle third, and specifically the quadriceps actually firing rather than the hip taking over.

There is a fourth thing nobody writes on a sheet, and in clinic it may be the most useful. Prehab is where you learn the exercises while the knee is relatively comfortable, so that in the first fortnight after surgery, when the knee is sore and the thigh has gone quiet, you are repeating something you already know instead of learning it. People who have done their quad sets fifty times before the operation find the muscle faster afterward, not because they are stronger but because they know what they are looking for.

There is one thing the guidelines ask for by name, and it is an appointment, not an exercise. The Aspetar guideline recommends at least one visit before the operation, to check that the thigh muscle switches on properly, to check there is no flexion contracture, meaning the knee is not stuck short of straight, and to go through what rehab after the operation is going to involve. More visits follow if either of those first two is a problem (Kotsifaki and colleagues, 2023). If nobody has offered you that appointment, it is a reasonable thing to ask for, and it is more use than another week of unsupervised quad sets.

None of this is a substitute for your own instructions. ACL reconstruction rehab sets out the whole program after surgery, and your surgical team's plan comes before anything on this site.

Does prehab make recovery after ACL surgery faster?

Possibly a little, in the things it trains. Not demonstrably in the things people hope for, and the evidence behind even that much is thin.

One systematic review has gone looking for randomized trials of preoperative rehab before ACL reconstruction. It found three. All three were judged at high risk of bias. The reviewers rated the certainty of the evidence as very low, and found a small benefit for quadriceps strength in one trial and for single leg hop scores in two, measured 3 months after surgery. Nothing in those trials assessed psychological outcomes, and there was no consensus on what a program should contain, how often it should be done, or how long it should run (Carter and colleagues, 2020).

What those three programs actually were is not what most people picture when they hear prehab. All three were exercise programs, mixing strength, control, balance and perturbation work in different combinations, and they ran from 10 to 24 sessions over 3 to 6 weeks. The reviewers add that the exercise was predominantly done with supervision (Carter and colleagues, 2020). So what was tested was a course of appointments, not a sheet, and that is where the small benefit came from.

The Aspetar guideline read the same literature and landed in a similar place, with one useful extra. It says prehab might improve quadriceps strength and knee range of movement after the operation and may shorten the time to get back to sport, all on very low certainty evidence, and that there was no effect from adding perturbation training to a preoperative strengthening program (Kotsifaki and colleagues, 2023). So nobody should be sold a specialized preoperative technique, and in particular nobody should be sold perturbation work as the active ingredient.

Set that against the other side of the ledger. The van Melick guideline, written for the Royal Dutch Society for Physical Therapy, recommends a prehabilitation phase as part of its evidence statement, alongside three criterion based phases afterward and 9 to 12 months of rehab in total. So this is mainstream practice with weak trial support behind it, which is true of a great deal of rehab and is not a reason to skip it.

The reason to do it anyway is the risk and cost. Ankle pumps and quad sets have very little downside in a settled knee, they cost nothing, and they put you at the start line in better shape. That is a different claim from shortening a 9 to 12 month program, and nobody should promise you the second one.

The prehab exercises, and how often to do them

This is the list most programs work through, in the order they tend to be added. Your own physio or physical therapist sets which of them you do and how far, and where their instructions differ from this, theirs win.

Two checks come first, and both are explained in full after the list. If the knee is locking, giving way, or swelling up within a few hours of ordinary activity, it needs looking at before you load it, and the standing exercises on this list wait until it has been. If something else was damaged in the same injury, particularly the meniscus, get your bending and weight bearing limits first, because this page cannot set them.

Set up for the standing ones before you start them. The mini squat, the calf raise and single leg stance all want a clear floor and something solid to grab. If you have fallen in the past year or feel unsteady, do the standing exercises next to a kitchen counter.

  • Ankle pumps: the easiest thing on the list and the one that keeps blood moving in the calf. Often done little and often through the day.
  • Quad sets: the thigh switching on. Watch the kneecap instead of trusting the feeling, because when the muscle fires properly the kneecap slides a little way toward your hip.
  • Seated heel prop: the weight of the leg easing the knee straight. The thigh has to go soft for this to do anything, which is where most people get it wrong.
  • Heel slides: bending, and only as far as you have been told you may bend.
  • Straight leg raise: added once you can lift the leg without the knee sagging into bend on the way up.
  • Glute bridge and mini squat: strength with both feet on the ground, inside a range you can control.
  • Calf raises and single leg stance: the calf, and standing on one leg next to a kitchen counter.

On dose, as a rough guide rather than a prescription: many programs do the early exercises little and often, something like 10 to 15 slow heel slides two or three times a day, 10 quad sets with a 5 to 10 second hold several times a day, and heel prop holds that start at a few minutes and build toward about 10 minutes, 3 or 4 times a day. The strength exercises often sit at 2 to 3 sets of 6 to 15, daily while the load is light and dropping back to two or three times a week once it is heavy enough to leave the thigh sore, so the muscle gets a recovery day.

On any morning the knee is more swollen than it was the day before, do the first four on the list and leave the strength work out until it has settled. Balance holds start short: a few seconds for each knee lift in single leg stance, building up as your balance improves. Each exercise page gives its own typical starting numbers. Your physio will adjust all of this to your knee.

This page is for adults. A child or teenager with a knee injury should be assessed by a doctor or physio before starting any exercise program. If you are pregnant, check with your midwife, doctor or physio before you start.

Those are the two checks, in full. A knee that is still locking, giving way, or swelling up within a few hours of ordinary activity needs assessing before it is loaded, and the warning signs below say how fast and who to go to. Until it has been checked, leave out the exercises on this list that put you on your feet, which here means the mini squat, the calf raise and single leg stance. If your knee is locked right now and will not fully straighten, get it assessed the same day before you start any of them, and do not try to work it straight: the quad set and the heel prop both push the knee toward the last part of straightening, which is the part a torn fragment caught in the joint blocks, and exercise will not free it.

And if another structure was damaged in the same injury, particularly the meniscus, ask what you may bend and what you may weight bear before you start, because that limit is usually tighter and is nobody else's to set. Meniscus tear covers what changes.

If somebody has offered you blood flow restriction training during the wait, that is a method a clinician sets up and supervises, with its own list of people who need clearance first. Blood flow restriction training explains what it is, who should not do it without clearance, and what to ask the person offering it. It is not a method to try from a page, and no pressures are published on this site for that reason.

How straight should the knee be before surgery?

Matching the other knee is the target to aim at, and that is not just custom. The Aspetar guideline asks for a preoperative check that there is no flexion contracture, meaning a knee that will not come fully straight, and for more visits before the operation if there is one (Kotsifaki and colleagues, 2023). What no published source does is put a number on how many degrees are acceptable on the day, so this page does not give you one either, and your own surgeon sets what your knee has to look like.

Why extension rather than bending: a knee that is short of its last few degrees of straightening before the operation turns up more often among knees that end up stiff afterward. In a retrospective series of 223 people who went on to need a second operation to free up a stiff knee after an ACL reconstruction, stiffness caused by scar tissue rather than by something else was associated with a knee that had been irritable before the reconstruction and with a knee that was already short of movement (Mayr and colleagues, 2004). That study looked backward at people who all ended up needing more surgery, so it cannot give you a risk figure, and an association found by looking backward does not show that getting those degrees back before your date prevents stiffness afterward. Nobody can promise you that. Use it as a reason to care about extension now, not as a reason to worry.

Surgeons genuinely differ on what follows from that. Some will wait for a settled knee that straightens fully before they operate, and will move a date to get it. Others operate on the knee as it is and work on extension afterward, and that is a defensible plan too, particularly where something else in the knee needs dealing with sooner. Which of those applies to you is your surgeon's call, not this page's, and it is worth asking them directly whether your date depends on your range.

None of that makes a longer wait free. The AAOS clinical practice guideline says that once an operation is indicated for a fresh, isolated ACL tear, it is better done early than late, because within 3 months of the injury the risk of further damage to the cartilage and the meniscus begins to climb, and it grades that Strong (Brophy and Lowry, 2023). Its recommendations on treatment are aimed mainly at younger, more active people, and the surgical ones rest on studies of ACL tears on their own rather than knees with several ligaments torn, so it will not speak for every reader of this page. Still, the direction is clear enough: prehab is what you do inside the wait you already have. It is not a reason to ask for a later date, and if you find yourself thinking it might be, that is a conversation to have with your surgeon rather than a decision to make at home.

Back to the knee itself: measure it instead of going by feel. Lie on your back with the heel propped and ask someone to look at both knees from the side: a gap under one knee that is not under the other is the deficit. Your physio measures it in degrees, and that is the number to tell your surgeon.

What you do not do is force it. Stretching harder is not how the last few degrees come back, and an irritated knee swells and loses more. The heel prop, done often, with the thigh relaxed, is the one that works, and patience is the active ingredient.

What to stop doing, and what to report before your operation date

The stop list is short, and it is mostly about not arriving with an angry knee.

Pivoting, cutting, jumping and anything that has already made the knee give way are out until your team says otherwise. Sport on an ACL deficient knee is where a meniscus gets torn, and a meniscus tear changes the operation and lengthens the rehab afterward. Deep or loaded bending is out unless you have been told the depth you may use. And do not use the last fortnight to catch up on strength work you meant to do earlier, because the swelling it causes is the thing your surgeon least wants to see.

Report any of these before your date rather than on the day: a knee that has become more swollen rather than less, a knee that has stopped straightening as far as it was, any new locking or catching, giving way, a fall, even one you were not hurt in, a temperature, feeling unwell or coming down with something, or a skin problem, cut, graze, bite or infection anywhere on the leg. Infection elsewhere counts too, including a chest or urine infection or a dental abscess, and so does a course of antibiotics you have been put on for any reason. The last group catches people out and any of it can move an operation, which is a nuisance and is a great deal better than an infected knee.

Say it out loud if you have gone backward. Nobody is going to be cross with you, and a surgeon who knows the knee has flared can plan for it. A surgeon who finds out on the day cannot.

What to arrange at home before the day

The practical half of prehab gets skipped and then costs a week. Do it while you can still drive.

Get the crutches and any brace before the operation if your team is providing them, and ask at your pre-admission appointment which it is, because plenty of hospitals hand them over on the day instead. If you do have them early, practice on your own stairs with a hand on the rail and somebody with you, not alone, because the first attempt on the day you come home is the worst time to find out. Do not buy a brace yourself. Whether you need one at all, and which one, depends on what was done inside the knee, and it is your surgeon's decision rather than a shopping one.

Sort out the sleeping arrangement: downstairs if your stairs are hard, with room beside the bed to get out on the operated side. Have something ready to raise the whole leg on, a cushion or a folded duvet under the heel and calf with the knee straight, and keep it out from under the knee itself. The NHS says to keep the leg raised when you rest and not to put a pillow under your knee. A pillow there holds the knee in a few degrees of bend for hours at a time, which works directly against the straightening everything else in this page is for.

Read the next part before your date, not after it. It is the one place where the usual advice flips.

There is one exception to raising the leg. If your toes are numb, tingling or burning, or the cast or boot feels tight, do not prop the foot higher than your hip and do not put ice on it, and read the warning signs below for what to do instead. The same exception applies to a brace or a bandage. If the foot beyond the bandage is numb, tingling or burning, if a brace or a bandage on the leg feels tight, or if the leg is getting tighter and more painful, loosen the straps or take the bandage off, keep the leg at about heart level rather than higher, leave the ice off, and read the warning signs below for what to do instead. Do not try to take a plaster cast off yourself. After an operation, the layer to take off is the outer bandage or wrap, along with any brace strap that is squeezing the leg, not the dressing stuck over the wound itself, which stays on and stays dry. Do not wait to get through to your team first: take the pressure off, then call emergency services straight away, and do not drive yourself.

The warning signs at the foot of this page are the ones for the knee you have now, before the operation. Once you have had it, the fuller list is on the ACL warning signs page, and it includes the signs of a clot in the lungs and of an infection in the wound or the joint, which belong to the weeks after surgery rather than the weeks before.

Put what you use daily between hip and shoulder height, so you are not bending or reaching in the first week. Then go round the floor the way a physio would: loose rugs, cables, anything that catches a crutch tip. The NHS asks people to clear the floors and take up what they could trip on before an ACL reconstruction, and the reason is worth saying out loud. A fall in the first weeks, onto a knee that has just been reconstructed and cannot yet protect itself, is the one setback on this list you can do something about in advance.

Work and driving need asking about rather than guessing. The NHS says to return to work when you feel ready, which is usually after about 4 to 6 weeks, but will depend on the type of work you do, and advises not driving until your medical team says you are fit to drive, and telling your insurer. Ask your surgeon about your own job in terms of specific tasks, kneeling, ladders, driving, long spells standing, carrying, rather than asking for a date.

Arrange the transport while you are thinking about it, because the NHS puts that on its list of things to sort before an ACL reconstruction and says you will not be able to drive for several weeks afterward. That starts with the day itself. Most people have this as a day case, so somebody has to bring you home, and an operating list that runs late is not the moment to be finding out who.

One thing this page cannot do for you is the pre-operative assessment. If you are asked to a pre-admission clinic a few weeks before the date, that appointment is there to check you are well enough for the operation to go ahead, and it is usually where the instructions about your medicines and about eating and drinking before surgery come from. Follow those, not this page, and do not stop or start any prescribed medicine before the operation on your own: tell them what you take and let them decide. If you smoke, that clinic is also the conversation to have, because stopping is on the NHS list of ways to prepare for this operation.

The same thinking applied to two other operations is on prehab exercises before a knee replacement and prehab before a hip replacement, and the practical side travels well between them even though the knee work does not.

What happens to this work after surgery

It carries straight on, which is the point of doing it.

The first stage of the program after your reconstruction has the same three aims as prehab and often the same exercises, done gently inside whatever limits you are given for weight bearing, bending and a brace. The difference is that the knee has had an operation, so it will swell more, the thigh will be harder to find, and the numbers come down before they go up. People who did prehab are often surprised by how far back the first fortnight takes them, so expect that rather than reading it as a failure.

For the arc of what comes next, ACL surgery recovery timeline sets out the stages and what tends to happen when. For the exercises themselves, stage by stage, with what has to be true before each stage starts, see ACL rehab exercises by phase.

One last thing before the operation, because it affects how you use the wait. Rehab after an ACL reconstruction carries on for 9 to 12 months (van Melick and colleagues, 2016), and the hardest part is not the first fortnight. It is the middle, when the knee feels normal for walking around and is nowhere near ready for sport. Prehab does not shorten that stretch. Knowing it is coming helps more than most exercises do.

This page is education rather than advice about your own knee. Your surgeon and your physiotherapist set what you do before your operation, and nothing here replaces the instructions they have given you.

Related exercise programs

Warning signs

Get emergency help now

  • Emergency: sudden, severe pain in your lower leg that is much worse than you would expect, especially with a tight bandage or brace on the leg. It may come with a tight, swollen leg, pain that gets worse when the muscle is stretched, numbness, pins and needles or weakness. Call emergency services or go to an emergency department straight away, and do not drive yourself. This can be acute compartment syndrome, which needs urgent surgery.
  • Emergency: the knee has moved out of place, looks misshapen or is pointing at an odd angle, or you have tingling or no feeling in the knee, leg or toes, or your foot turns cold, pale or blue. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
  • Emergency: the whole knee, not just the kneecap, felt as though it slid or shifted right out of place at the moment of injury, even if it went back straight away, or the knee now feels loose or wobbly in more than one direction. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance. A knee that comes out of place and goes back can tear several ligaments at the same time and can damage the artery or the nerve behind the knee. That damage is not always obvious at first, and the knee can look almost normal, so it is checked in hospital on the day rather than worked out at home.
  • Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.

Get help today

  • Same day: the knee is locked, which means it is stuck bent and you cannot fully straighten it, even after gently trying to move it, or you cannot bend or straighten the leg at all. Get assessed the same day by a doctor, at urgent care or at an emergency department. A torn piece of meniscus can get caught in the joint and block it, and when a tear like this can be repaired, it should be done as early as possible. A knee that catches for a moment and then frees itself can happen with a meniscus tear. That is not the same as a locked knee, but tell your physio or doctor about it.
  • Same day: the knee straightens when someone else moves it for you, but you cannot lift the straight leg off the bed yourself or hold the knee straight against gravity, or you can feel a gap or a dip just above or just below the kneecap. Get assessed the same day by a doctor, at urgent care or at an emergency department. The tendon that straightens the knee can tear, which is not a meniscus or a ligament problem and is not treated with exercises. It is usually repaired, and a tendon repaired late does less well than one repaired early.
  • Same day: the knee keeps giving way under you, or it gave way after a recent injury, or it gives way and is also very painful or swollen. Get medical advice the same day. If it only happens now and then, with no recent injury and no swelling, it is not an emergency, but book an assessment with a physio or doctor in the next few days. Until it has been checked, leave out the exercises you do standing on one leg, hold the rail on stairs and take care on uneven ground, because a knee that gives way without warning is how people fall.
  • Same day: you cannot walk or put weight on the leg, whether or not there was a fall or injury, or you have very bad knee pain after a fall or injury, or very bad knee pain that came on suddenly with no injury at all. Get medical advice the same day.
  • Same day: the knee swells up with no clear reason, especially if you take medicine to thin your blood. Get medical advice the same day.
  • Same day: the knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
  • Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
  • Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.

Book an appointment

  • Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.

Common questions

How many weeks of prehab should I do before ACL surgery?

There is no agreed number, and the review that looked for one says so: it found no consensus on the content, frequency or length of a prehab program across the three trials it could include (Carter and colleagues, 2020). In practice the length is decided by your surgery date, not by a protocol, and most people get somewhere between a couple of weeks and a couple of months because that is how long the wait happens to be. For scale, the three trials in that review ran 10 to 24 sessions over 3 to 6 weeks, predominantly with supervision, so a short supervised block is what the small benefit was measured from. Work inside that wait; do not try to extend it. The AAOS clinical practice guideline prefers early reconstruction once the operation is indicated, because the risk of further cartilage and meniscus damage starts to rise within 3 months, graded Strong (Brophy and Lowry, 2023). Moving a date is your surgeon's clinical judgement, and it is not something to ask for so that you can fit more prehab in. What matters more than the number of weeks is the state the knee is in on the day: straightening fully, settled rather than swollen, and a thigh you can switch on. If your date is close and the knee is nowhere near that, say so to your surgeon rather than training harder in the last week.

Does prehab shorten ACL recovery?

The evidence does not support promising that. Three randomized trials have tested preoperative rehab before an ACL reconstruction, all were judged at high risk of bias, and the reviewers rated the certainty of the evidence as very low. What they found was a small benefit for quadriceps strength in one trial and for single leg hop scores in two, measured 3 months after surgery. No trial looked at the psychological side at all, and none gave a usable answer about return to sport (Carter and colleagues, 2020). So prehab is reasonable, cheap, low risk and what the van Melick guideline recommends. It is not a documented shortcut to the far end of a program that runs for 9 to 12 months.

Should my knee be fully straight before ACL surgery?

Full straightening, matching the other knee, is the target most teams work toward before the operation, and the reason is what stiffness afterward costs. In a retrospective series of 223 people who needed a second operation to free up a stiff knee after an ACL reconstruction, the ones whose stiffness turned out to be scar tissue rather than something else were more likely to have had an irritable knee or already restricted movement before the reconstruction (Mayr and colleagues, 2004). That is a look back at people who all ended up needing a further operation, so it cannot tell you the odds for your knee, and it is one reason some surgeons wait for a settled, straight knee rather than operating on an angry one. Your surgeon decides whether your date moves, not you and not this page. Tell them where the knee has got to, in degrees if your physio has measured it.

Can prehab make the swelling worse?

Yes, and swelling is the dial to steer by rather than pain. A stretching feeling, mild stiffness or an ache that settles soon after you finish is expected. A knee that is clearly more swollen or sorer the next morning means the session asked too much, so drop back a step rather than stopping altogether. The reason the next morning is the judge is that knee swelling rarely shows up during a session: it arrives that evening or the following day. If the swelling keeps building rather than settling, or the knee swells up within a few hours with no clear reason, that is in the warning signs on this page rather than something to train around.

Is there an ACL prehab sheet I can print?

The one to use is the one your own physio or physical therapist gives you, because it will carry your range limits and your dose. If you want something to work from in the meantime, the exercise list in the section above is laid out in the order most programs use it, and every exercise on it has its own page with a video, the common mistakes and a typical starting dose. Write down the ones you were actually given, with your own numbers next to them, and take that to your next appointment to be corrected. A generic sheet with no range limit on it is the one thing to avoid, which is exactly the risk with a PDF found through a search.

Can I still exercise the rest of my body before ACL surgery?

Usually yes, and most people should. The upper body, the trunk and the other leg are not injured, and keeping them going is some of the best use of a wait: single leg work on the uninjured side, upper body strength, and whatever cardio your knee tolerates without swelling afterward. Ask your physio which of it is in and which is out, because the answer depends on how stable your knee is and on what else was damaged. If anything you try leaves the knee more swollen the next morning, that is the knee telling you it was involved after all.

References

  1. Carter HM, Littlewood C, Webster KE, Smith BE. The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review. BMC Musculoskeletal Disorders. 2020;21(1):647. https://doi.org/10.1186/s12891-020-03676-6
  2. van Melick N, van Cingel REH, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British Journal of Sports Medicine. 2016;50(24):1506-1515. https://doi.org/10.1136/bjsports-2015-095898
  3. Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 2023;57(9):500-514. https://doi.org/10.1136/bjsports-2022-106158
  4. Brophy RH, Lowry KJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2023;31(11):531-537. Guideline approved by the AAOS Board of Directors 22 August 2022. https://doi.org/10.5435/JAAOS-D-22-01020
  5. Mayr HO, Weig TG, Plitz W. Arthrofibrosis following ACL reconstruction: reasons and outcome. Archives of Orthopaedic and Trauma Surgery. 2004;124(8):518-522. https://doi.org/10.1007/s00402-004-0718-x
  6. American Academy of Orthopaedic Surgeons. ACL injury: does it require surgery? OrthoInfo. https://www.orthoinfo.org/en/treatment/acl-injury-does-it-require-surgery/
  7. NHS. ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/what-it-is/
  8. NHS. How to prepare for ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/preparing/
  9. NHS. Recovering from ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. https://www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery/recovering/
  10. NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-24.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.