Your Return to Sport Plan
Recovery from ACL reconstruction is not a single event — it is a process that unfolds over roughly two years. Before we get into what you need to do at each stage, it helps to understand the shape of that recovery: what happens to your strength, and why.
Understanding the curve
Throughout your recovery, we track one number: your Limb Symmetry Index (LSI) — how strong your operated leg is compared to your other, uninjured leg, expressed as a percentage. If you plot this against time, from now through to two years out, it traces a very particular shape. Understanding that shape is the key to understanding your whole recovery.
Right now, because of your injury and the disuse that comes with it, your leg strength is likely around 60% of your other leg. This is completely normal.
Before surgery, we focus on prehabilitation — building your strength as high as possible ahead of time. With enough time, we can often bring this up to around 80%.
After surgery, something counterintuitive happens: your strength continues to fall, even though the reconstruction itself is done. You'll be in a knee brace, and your quadriceps muscle will not fire properly in these early weeks — a natural response to swelling and pain, not a sign anything is wrong. Strength keeps dropping until it bottoms out at around 40%, roughly 6 weeks after surgery. This dip is expected. Every patient goes through it.
How quickly you're allowed to put weight back on the leg during this window depends on exactly what was done in surgery, not just the ACL reconstruction itself. If you had an isolated ACL reconstruction, you can usually fully weight-bear as tolerated after 2 weeks. But if your surgery also involved repairing an unstable meniscus tear, that repair needs time to heal before it can take load, so you'll be kept on partial weight-bearing for up to 6 weeks. We'll tell you exactly which category you fall into before you leave hospital — and this is also why the timing of Phase 3, when you relearn to walk without any aids, can look quite different from one patient to the next.
From that low point, the curve turns and begins climbing steadily. By 6 months, most patients reach around 70% — the point at which we test and, if you meet the mark, clear you to begin jogging. By 12 months, the goal is 90–100% — full symmetry with your other leg — which clears you to return to training in pivoting sports (not yet competition, but full training).
So the overall shape is: a modest rise before surgery, a sharp fall for the first six weeks after, and then a long, steady climb back to symmetry over the following year. That dip is not a setback — it's a predictable and necessary part of healing.
The gates matter more than the dates
The timeline above is a guide, not a guarantee. Patients who are more consistent and compliant with rehab may reach these milestones a little faster — but we never rush this process. The 70% and 100% marks are gates, not dates: you move to the next stage when your knee is ready to, not because a certain number of weeks has passed.
It's also worth knowing that strength is only one part of the picture. Some patients reach 100% LSI and still hesitate to return to sport, because of a natural fear of re-injury. This psychological piece is real, and it doesn't show up on the chart. What we do know is that when your strength is strong, your confidence in your knee tends to follow.
What each phase involves
Now that you understand the shape of the recovery, here is what happens — and what's expected of you — at each stage along that curve.
Before surgery, we assess your baseline function with our clinical exercise physiologist so we can track your progress over the next two years. You'll also begin physiotherapy (prehab) and Neuromuscular Electrical Stimulation (NMES), and take prescribed medication to wash the leg and clear surface bacteria ahead of surgery.
Your wound needs about two weeks to heal. Keep the area cool and dry, and avoid sweating. Focus on: NMES twice daily, physiotherapy compliance, working towards full extension of the knee, and following your weight-bearing instructions exactly.
Your wound has healed and dressings are no longer needed. Continue NMES and physiotherapy, working towards your full range of motion as permitted by your brace.
This phase is about relearning to walk without crutches or a brace. As explained above, how long it takes depends on your surgery — an isolated ACL reconstruction versus one involving a meniscus repair can mean a very different starting point here. By the end of this phase, you should be walking normally.
Phase 4 (3–6 months) — Symmetrical strength
This is where the real work begins. You'll need a gym membership, focusing on three exercises: leg extension (quadriceps), hamstring curl (hamstrings), and leg press (glutes).
At 6 months, an isokinetic strength test checks whether you've reached the 70% LSI gate. If so, you begin jogging, sport-specific physiotherapy, and structured strength-and-conditioning work.
At 12 months, the test is repeated. Reaching 90–100% LSI clears you to return to training in pivoting sports.