Returning to Sport After ACL Surgery: Recovery Timeline & Steps
- Isabel Jones, PT, DPT, ATC
- Jun 24
- 7 min read
Article Updated: 6/24/2026
Original Publish Date: 11/14/2022
An anterior cruciate ligament (ACL) tear is an extremely common injury in athletes; approximately 200,000 ACL injuries are diagnosed each year in the U.S. alone. ACL injuries can be devastating to athletes, as the recovery process is lengthy and requires commitment; however, returning to sports before the recommended time frame can delay the healing process and risk re-injury. According to the Journal of Orthopaedic & Sports Physical Therapy, athletes who returned to sports too soon after ACL surgery (before nine months), were associated with a seven times increased rate of a second ACL injury.
Do You Have to Do Physical Therapy After an ACL Tear?
Yes, proper rehabilitation after ACL surgery is required in order to be as safe as possible and maximize the potential for returning to daily life and competitive sports. Having proper ACL rehabilitation also helps to improve confidence within the patient; it guides them through the necessary steps while respecting the tissue healing process, and also helps to decrease the incidence of a second ACL tear. ACL surgery requires a long rehabilitation process, and as physical therapists, we know that the long road to recovery is often a very frustrating experience for athletes. That’s why we are there for guidance and support during the process to improve the overall outcomes of the patient, with the main goal being to return to the sport that they love.
When Should an Athlete Begin PT After Surgery?
An athlete can begin sports physical therapy as soon as a few days after surgery, depending on the surgeon's guidance. Physical therapists prefer to see patients as early as possible in order to start working on decreasing swelling, improving range of motion, managing pain/discomfort, gait training, improving muscle activation, and education on the rehabilitation process while respecting the surgical site.
What Does the ACL Recovery Timeline Look Like?
The recovery timeline varies depending on the patient, their goals for rehabilitation, what sport they are returning to, and what their prior level of function was. Each individual heals at different rates, therefore every patient’s recovery will look a bit different. Typically, for athletes, we are looking at a 9 to 12-month recovery timeline.
Early Stage
The early stage of rehabilitation focuses on managing pain, decreasing swelling, improving range of motion, re-introducing muscle activation, normalizing the gait pattern while walking, and improving proprioception (one's ability to sense where their body is in space).
Early-Mid Stage
The early-mid stage of ACL rehabilitation continues to utilize principles from the early stage, as well as progressing to strengthening exercises in multiple directions, proprioception, and balance.
Mid-Late Stage
The mid-late stage of ACL rehabilitation focuses on force absorption, learning how to decelerate the knee, and improving single-leg loading mechanics in order to help the patient return to running.
Late Stage
The late stage of ACL rehabilitation mainly focuses on improving single-leg power development, landing mechanics, change of direction, neuromuscular control, and an increase in sport-specific activities in order to help return the patient to competitive gameplay.
When Can You Return to Sport After ACL Surgery?
In order to be cleared for a sport after an ACL surgery, a return to sport assessment is necessary. This assessment is a detailed evaluation of strength, balance, range of motion, motor control, and sport-specific movement patterns. The assessment will only be conducted once a physical therapist deems that it is safe for the patient to perform the testing protocol.
The return to sport assessment is usually administered between 9-12 months post-op after the patient has gone through a rigorous rehabilitation program that focuses on mobility, muscular and ligamentous strength, endurance, power, shock attenuation, loading mechanics, change of direction/agility, neuro-cognitive development, and sport-specific activities.
Once the patient has achieved a passing score on the testing protocol, the patient will be cleared to return to their sport.
What does the ACL Return to Sport Assessment Test for?
The return to sport assessment will vary significantly depending on the sport and the PT provider. Ultimately, we are looking to see if the patient meets specific functional benchmarks to ensure the patient is ready for the increased stress on the knee for their specific sport, position, and intensity of the game.
At Rehab United, we have created an extremely extensive and unique multi-stage protocol based on current physiological and post-operative literature, which will properly assess patients' readiness for the demands of their respective sport. Sports clearance benchmarks include:
Running Clearance
To be cleared for running, the patient must demonstrate basic plyometrics, including solid landing mechanics and symmetric force absorption. As you place 1.5 to 3 times your body weight in force while running, training for this test often includes weightlifting exercises (like squats) to increase the load above body weight.
Sprinting & Cutting Clearance
These activities require lateral and rotational loading at speed, meaning the patient must have the agility to suddenly brake, twist, and change directions. To do this, we must ensure that the patient can safely perform dynamic movements in all three planes of motion, meaning side to side, forward and backward, and with rotation.
Final Clearance
When it's time for the final return to sport evaluation, a standard strength test isn't enough. To truly mimic the demands of a real game, our comprehensive assessment tests the athlete twice, once while refreshed and once while fatigued.
Fresh State Testing
We begin by measuring the absolute strength and stability through functional activities while the athlete is completely fresh. We are looking for a high level of side-to-side symmetry, meaning the injured leg is performing as well or nearly as well as the uninjured leg when it comes to strength, power, and agility.
Fatigued State Testing
This is the most critical component of the assessment. Many athletes can maintain great mechanics when they are fresh, but once an athlete's body is fatigued, the quality of their mechanics often degrades. For this reason, we repeat our stability and strength tests after inducing a fatigued state. This allows us to see if the athlete's muscle firing patterns and joint control hold up through the end of a game, when fatigue sets in, and the risk of re-injury is highest.
The Mental Component of Returning to Sport
Knowing a player is physically ready to return to sport is only half the battle; they must also be mentally ready. While PT assessments tell us the patient has met the physical standards, they also serve to reassure the player that they are ready for that next important step. As physical therapists, we communicate with the patient throughout their recovery to ensure they are feeling ready and confident to get back to high-level athletic performance.
Strategies for Preventing ACL Injuries
Although ACL tears cannot be fully prevented, there are steps you can take to reduce the risk of injury (or re-injury). The main focus of these strategies is focusing on single-leg strengthening, improving cutting mechanics, and increasing the body’s ability to control the knee joint. The exercises listed below give an idea of what athletes should be working on in order to help reduce the risk of ACL tears. If you want a customized program specific to your sport, we recommend looking into preventative physical therapy or athletic performance training.
Sample Preventive Exercises:
1. Single-Leg Retro Squat Off a 12” Box With a Medicine Ball Diagonal Chop
2. Single-Leg Balance 3-Way Posterior Reach Off 6” Box
3. Depth Jumps From a 12” Box
This video covers all three examples in the respective order:
How Rehab United Works With Athletes for ACL Recovery
Rehab United works with San Diego athletes from their first visit post-op through the return to sport phase and eventually clears athletes for a full return to their sport. We use a comprehensive approach for athletes who are rehabilitating from ACL reconstruction and utilize the principles of Applied Functional Science to aid in this process.
Our Unique Approach to ACL Recovery
We address not only the knee joint but every joint in the body. Athletes utilize their entire body in order to participate in their sport, and when athletes are recovering from ACL reconstruction, it is important to not only treat the knee joint, but also the surrounding joints that can affect the knee. The main focus at Rehab United is facilitating and guiding the patient through the rehabilitation process and making it as fun and rewarding as possible. It is our main goal to return athletes to the sport they love as safely and with as much confidence as possible. This means not only addressing the physical barriers to return to sport, but the mental ones as well. The fear of reinjury can hinder high-level performance, so we also work to ensure the athlete feels comfortable and confident returning to their sport.
Recover with Rehab United!
We strive not only to return athletes back to their prior level of function but to exceed expectations and optimize their performance. Our physical therapists focus on providing comprehensive sports rehabilitation for all types of athletes. If you have a sports injury, recover with us! Request an appointment today.
Author: Isabel Jones, PT, DPT, ATC
Dr. Jones is a physical therapist and a Certified Athletic Trainer with a passion for physical activity and functional movement. She received her Doctorate of Physical Therapy in 2021 from the University of St. Augustine in San Marcos, CA.
With Contributions from: Bryan Hill, PT, FAFS, CF-L1, BRFC
Bryan Hill is the Chief Executive Officer and co-owner of Rehab United Sports Medicine and Physical Therapy. Bryan received his bachelor’s degree in Physical Therapy and Health Sciences from the University of New England and has been a physical therapist in the San Diego community since 1998. Through a close professional and personal relationship with renowned therapist Gary Gray, and as a member of the inaugural class of The Gray Institute for Functional Transformation (GIFT) fellowship, Bryan has been a strong advocate, pioneer, and expert in the principles of Applied Functional Science. Throughout his experience as both a clinician and an educator in the field, Bryan has not only treated a wide range of patient/athlete demographics and diagnoses, but has also helped inspire and lead San Diego’s aspiring clinicians to become the future of medicine.