ACL RECONSTRUCTION · THE FULL ARC
TWELVE WEEKS,
one day at a time.
You leave the hospital on crutches with a printout. The surgery took an hour; the recovery takes months — and almost all of it happens at home, between appointments, where nobody is watching.
This guide is the map: what published rehabilitation protocols describe week by week after ACL reconstruction, what tends to change the timeline, and the small number of things that should make you pick up the phone. It is general education, not your program.
The shape of the recovery
Published protocols — like the NHS guidance on recovering from ACL surgery and the Cambridge University Hospitals rehabilitation protocol — commonly describe the arc in overlapping phases rather than fixed dates:
| Phase | Rough window | What published protocols emphasise |
|---|---|---|
| Protect & settle | Weeks 1–2 | Swelling control, wound care, regaining full knee extension, waking the quadriceps up |
| Move & load | Weeks 2–6 | Normal walking, range of motion, early strength work |
| Build | Weeks 6–12 | Progressive strengthening, balance, single-leg control |
| Run | Months 3–6+ | Graduated return to running, if criteria are met |
| Return to sport | Months 9–12+ | Sport-specific work and testing — the NHS notes it can take up to a year to return to sport |
The dates are ranges, not promises — progression in most published protocols is criteria-based (what your knee can do), not calendar-based (what day it is).
Week by week
- Week 1 — days 1–7: protect, elevate, straighten
- Week 2 — days 8–14: the review, the extension battle
- Week 3 — days 15–21: the motivation cliff
More weeks are being added. Each page covers what the published protocols focus on that week, what tends to feel hard, and what's worth asking your physio about.
What changes the timeline
None of these mean your recovery is going wrong — they mean your protocol will differ from the generic one:
- Graft type. Hamstring, patellar tendon, quadriceps tendon, and allograft each come with different early restrictions and soreness patterns — OrthoInfo (AAOS) outlines the trade-offs.
- Meniscus repair at the same time. Often adds weight-bearing or range restrictions in the early weeks. If your protocol is more conservative than your mate's, this is usually why.
- Your knee before surgery. Swelling, range, and quad strength going in shape the first weeks coming out.
- Your surgeon's protocol. Genuinely different between clinics — neither faster nor slower is "better", and comparing calendars with strangers on the internet is how anxiety starts.
Who this guide is not for
This guide assumes a diagnosed ACL injury treated with reconstruction. It is not for undiagnosed knee pain, acute emergencies, or deciding whether to have surgery — those are conversations for a clinician, not a website.
Sources: NHS — Recovering from ACL surgery · Cambridge University Hospitals — ACL reconstruction rehabilitation · OrthoInfo (AAOS) — ACL injuries
BETWEEN APPOINTMENTS
Recovery happens day by day.
So does Protocol.
Protocol is a recovery coach in your pocket — it knows what day you're on, reads the reports you upload, and checks in daily through the weeks between physio visits. It doesn't diagnose or treat. It helps you show up.
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