ACL reconstruction is a common orthopedic procedure, especially for active individuals who have injured their knee. While surgery is important for graft placement, the physical therapy (PT) that follows is the primary driver of a successful recovery. The goal is to restore full function to the knee joint, requiring a lengthy commitment to rehabilitation. The frequency of PT visits changes significantly as recovery progresses from the immediate post-operative period to a full return to activity.
The Intensive Early Phase: Frequency and Goals
The initial phase of recovery, spanning the first four to six weeks, requires the highest frequency of physical therapy visits. Patients attend supervised PT sessions two to three times per week during this period. This high frequency allows the therapist to closely monitor the healing surgical site and manage immediate post-operative symptoms, such as pain and swelling.
The primary goals of this intensive period focus on achieving foundational mobility and muscle activation. A major objective is restoring full knee extension, meaning the leg can be straightened completely, matching the uninjured leg. Patients also work on increasing knee flexion, aiming for at least 90 degrees of bending within the first few weeks. Early activation of the quadriceps muscle is necessary to prevent muscle wasting, often using techniques like quadriceps sets and straight leg raises.
This initial frequency ensures the patient safely begins a home exercise program (HEP) and avoids complications like joint stiffness. Supervised sessions perform gentle range-of-motion exercises and establish a normal gait pattern, using crutches if required. By the end of this phase, the patient should have minimal pain, reduced swelling, and demonstrate an active quadriceps contraction without the knee lagging.
Transitioning Frequency: Independence and Progression
Once initial goals of pain control, reduced swelling, and basic range of motion are met, clinic visits begin to taper down. This transition starts around six to eight weeks post-surgery, shifting the focus toward greater patient independence and functional strength. Clinic attendance decreases to once or twice per week, and eventually, patients may only see their therapist once every two weeks for program advancement.
This decreased clinic frequency corresponds with increased reliance on the home exercise program. Exercises performed at home become more challenging and frequent, requiring the patient to dedicate time to strengthening and balance activities multiple times a week. The focus of this phase changes from achieving basic mobility to building muscle strength and improving neuromuscular control.
Goals progress to include challenging closed-chain exercises, such as squats and leg presses, and the introduction of stationary cycling for endurance. This stage emphasizes the Limb Symmetry Index (LSI), comparing the strength of the surgical leg to the uninjured leg to progressively close the strength gap. The physical therapist acts as a coach, modifying the HEP based on the patient’s progress with strength and stability.
Total Duration and Determining Discharge
Full recovery requires nine to twelve months, extending far beyond the time spent in the clinic. Supervised clinic visits conclude between four and six months post-operation, but the patient must continue a rigorous, unsupervised exercise program until cleared for a full return to activity. The total number of supervised PT visits averages around 16, though this varies based on insurance and individual needs.
Formal discharge is determined by achieving specific, objective criteria, not by the passage of time. The most important metric is quadriceps strength symmetry, which must be greater than 90% compared to the uninjured leg. Therapists use isokinetic testing or dynamometers to measure this strength index and ensure the operated leg can handle high-level activity.
In addition to strength, the patient must complete a battery of functional performance tests, such as single-leg hop tests for distance and balance assessments. These tests objectively measure the ability to absorb shock and rapidly change direction without stressing the new graft. Achieving these functional and strength milestones marks readiness for discharge and a safe return to demanding activities.
Individual Factors That Modify the PT Schedule
The standardized PT schedule is adjusted based on several factors related to the surgery and the patient. The type of graft used influences the timing of certain exercises. For instance, a hamstring autograft may delay the introduction of resisted hamstring exercises to allow the donor site to heal. Conversely, a patellar tendon graft may necessitate slower progression due to potential anterior knee pain.
Concurrent injuries, such as a meniscus repair or cartilage damage, alter the initial PT schedule and restrictions. A meniscus repair requires limited weight-bearing and restricted knee flexion for several weeks, slowing early progression and increasing the need for supervised visits. These additional procedures introduce different biological healing timelines that override the ACL protocol.
A patient’s consistent adherence to the home exercise program is another factor affecting the required frequency of clinic visits. Patients who diligently perform exercises outside of the clinic progress faster and require fewer supervised sessions to advance their program. Conversely, slower progression or lack of compliance may necessitate more frequent therapist check-ins to ensure proper technique and motivation.