ACL reconstruction is a 9-month rehabilitation, not a 3-month one. Patients who return to sport before completing the full program and passing return-to-sport criteria have substantially higher rates of re-injury. Our program follows the most recent evidence-based protocols and uses validated return-to-sport testing before clearing patients for return.
Phases of ACL rehabilitation
- Phase 1 (weeks 0–6) — Protection:Focuses on pain and swelling control, restoring range of motion (prioritizing full extension), quadriceps activation, and gait normalization.
- Phase 2 (Weeks 6–12) - Recovery: Emphasizes progressive strengthening, single-leg balance work, stationary cycling, and a safe return to gym exercises.
- Phase 3 (Months 3–6) - Build: Introduces running progressions, agility drills, plyometrics, and sport-specific movements.
- Phase 4 (Months 6–9) - Return to Sport: Advanced plyometrics, sport-specific drills, contact progression, and formal return-to-sport clearance testing.
Return-to-sport criteria
Before clearance for pivoting sports, patients must meet strict objective criteria. This includes a Limb Symmetry Index (LSI) above 90% on quadriceps and hamstring strength testing, as well as an LSI above 90% across a battery of hop tests (single, triple, crossover, and timed). Additionally, patients must demonstrate psychological readiness, zero pain or apprehension, and a minimum of 9 months recovery time post-surgery. We administer these evaluations and provide a formal written clearance report for the patient and surgeon.
Outcome measures we use
- KOOS
- International Knee Documentation Committee (IKDC) Subjective Knee Form
- Tegner Activity Scale
- Lysholm Knee Score
- Hop Test Battery
- Isokinetic Quadriceps and Hamstring Strength Testing
- ACL-Return to Sport after Injury (ACL-RSI) scale
Who leads this work at Kent
ACL rehabilitation at Kent is delivered by Tresha Parmar with specific sports rehabilitation and return-to-sport testing training.
Frequently asked questions
When can I run after ACL reconstruction?
Typically around 12 weeks post-surgery, once range of motion is full, quadriceps strength is adequate (typically 70%+ of the other leg), and there's no swelling. Earlier running is a re-injury risk.
When can I return to my sport?
Pivoting sports (football, basketball, tennis, rugby, netball): typically 9 months minimum, after meeting return-to-sport criteria. Non-pivoting sports: often earlier. The criteria — not the calendar — determine clearance.
Do I really need 9 months of rehabilitation?
Yes for pivoting sports. Patients who return earlier have higher re-rupture rates. The 9 months reflects graft maturation, neuromuscular re-learning, and the time needed to pass objective return-to-sport criteria.
What if I had ACL surgery years ago and never finished the rehabilitation?
We assess you and design a program around what you need now. Many post-ACL patients have persistent quadriceps weakness, asymmetry, or fear of re-injury that responds well to structured work.
Do you work with my surgeon?
Yes. We send progress reports at each phase transition and at return-to-sport clearance. For complex or revision ACL cases we coordinate more closely throughout.