Football, soccer, and basketball. These three sports top the charts for ACL injuries. Most of the time they happen without contact. Just one quick pivot, or sharp change in direction. And when it happens, one big worry crosses every athlete's mind:
ACL surgery. And along with that, the hope of avoiding the knife.
Can the ligament heal on its own with the right rehab? Or is surgery the only path forward?
ACL reconstruction is one of the most common orthopedic surgeries in the U.S., with over 400,000 procedures each year. The success rate is high, but recovery takes time.
It all starts with an MRI. Once you have got a clear diagnosis, doctors will map out your ACL injury treatment. So what comes next?
In this article, we’ll walk you through ACL recovery timelines, as well as physical therapy and rehabilitation options for athletes, and everyone who needs to heal from a knee injury.
Understanding ACL Injuries
So first things first: what is the ACL? Its full name is the anterior cruciate ligament, and it helps control forward motion and rotation in the knee. It crosses inside the knee joint with the PCL (posterior cruciate ligament), forming an “X” that keeps everything moving in sync.
The ACL is one of the main ligaments that keeps your knee stable. Its job is to stop your shinbone (tibia) from sliding too far forward on your thighbone (femur), and it also helps limit excessive rotation.
As we mentioned, most ACL injuries actually happen without contact. So not necessarily big crashes or tackles. It’s more usually a planted foot, a sudden twist, a fast pivot. It’s a snap, and the player collapses.
You have probably seen it. A football or soccer player cuts too hard and drops, no one even touched them.
Even though 70% of the ACL tears happen with no contact, they can also occur from a bad tackle or an awkward landing while trying to avoid a fall.
But we can tell you one thing for sure: When it happens, you usually know. The knee swells up fast. Some athletes even hear or feel a “pop.” That’s often the first red flag for an ACL tear.
When does an ACL injury need surgery?
Whether surgery or not, that will depend on each specific case and what doctors say. They will evaluate your knee injury with an MRI and physical tests, to determine the best recovery treatment.
Here’s what the situation may look like:
If your ACL is the only structure injured, but your meniscus, cartilage, and other ligaments are intact, good news: non-surgical ACL treatment might be an option. That’s because those surrounding tissues can still help stabilize the knee.
But if there’s more damage on the meniscus or other ligaments, surgery becomes more likely.
To get the full picture, let’s take a quick look at the different grades of ACL injuries.
Grades of an ACL Injury
How serious can an ACL injury be? We usually break it down into three grades, from mild to severe:
- Grade 1: Mild ACL sprain: The ligament is stretched, but not torn. How does it feel? There’s some discomfort, mild swelling and stiffness, but the knee stays stable. You might feel sore, but you can still walk and bend the joint.
- Grade 2: Partial ACL tear: This one’s more painful. The ligament is partially torn, so expect more swelling, possible bruising, and a noticeable sense of instability. Walking becomes harder, and you might limp or find it tough to put full weight on the leg.
- Grade 3: Complete ACL tear: This is the news no athlete wants to hear; it means the ligament is completely torn. Pain is sharp, swelling shows up fast, and the knee usually can’t support your weight. It might buckle or give out when you try to walk.
For all ACL injury grades, there is a way to heal. It takes patience, consistency, and expert care.
ACL Injury Treatment Options
Let’s take a look at what ACL recovery typically involves. We’ll also cover a few additional treatments doctors might recommend, depending on your evaluation and how that ligament’s looking.
For starters, the main treatment for an ACL injury usually includes:
- Physical therapy
- Rest
- Knee bracing
- Ice and compression to reduce swelling
We have already shared some knee rehab exercises here, so feel free to check this guide. In short, ACL rehab includes a mix of recovery exercises focused on strength, stability, and balance. The goal is to teach your body to both generate and absorb force again.
That’s why ACL rehabilitation for athletes combines:
- Strength exercises to rebuild general leg power. These include leg presses, hamstring curls, Romanian deadlifts, and split squats.
- Stability and balance drills to improve control and coordination. Here we can include single-leg balance, BOSU ball holds, lateral band walks, and single-leg romanian deadlifts.
- Plyometric movements to prepare for return to sport. Here you can expect exercises like box jumps, single-leg hops, and lateral bounds.
As you progress, these ACL recovery exercises will evolve with you. Here at P1, our expert physical therapists often incorporate other non-surgical treatments like IASTM and Manual Fascial Stretch, that help the knee heal for good.
If your injury is especially painful—like a grade 3 ACL tear—doctors may also prescribe painkillers or anti-inflammatories to help manage discomfort early on. Also, a great non-invasive alternative is HBOT, great to help with pain management.
Now, let’s talk about the thing no athlete wants, but sometimes can’t avoid: surgery. Here we have two main procedures: ACL reconstruction and ACL repair.
Most athletes who undergo surgery will have ACL reconstruction. This means the surgeon builds a new ligament using a graft, usually from another tendon—either from your own body or a donor.
In short: reconstruction replaces the torn ACL with a new tendon.
Then there’s ACL repair, which is less common. In this procedure, the surgeon reattaches your original ligament if it has pulled away from the bone but remains intact. Just keep in mind this option is less common, mostly used in younger athletes with specific types of tears.
Rehabilitation and Recovery After ACL Injury
Time to talk about… recovery time. Sometimes, ACL surgery can’t be avoided. And when that’s the case, recovery will take longer, usually 9 to 12 months before returning to full activity.
Grade 1 ACL injury takes less time to heal. If doctors determine that surgery isn’t needed and a conservative treatment approach is possible, you may be looking at 3 to 4 months to return to sport-level activity.
Still, full healing of the ACL—regardless of surgery—usually takes 8 to 9 months, assuming you follow expert recovery instructions consistently.
Your exact ACL recovery timeline will depend on what your doctors and physical therapists recommend. But in general terms, we can break the process down into five key phases:
Phase 1: Post ACL Injury Recovery (First 2 Weeks)
Recovery starts immediately. The main goals in the first couple of weeks are to:
- Reduce swelling
- Protect the knee
- Begin gentle movement
This means plenty of rest, ice, compression, and elevation (R.I.C.E.), along with knee bracing.
You’ll also begin very light rehab activities, like heel slides and quad sets, to restore range of motion and start walking again with proper form.
Phase 2: Strengthening & Flexibility (3-6 weeks)
By week 3, swelling should start to fade. You’ll begin adding strength and mobility exercises, guided by your physical therapist.
Expect movements like:
- Leg raises
- Stationary biking
- Mini-squats
It’s important to be honest with your therapist and not overdo it. These ACL recovery exercises may cause some discomfort, but they should not cause pain. As you continue, you’ll regain strength and motion.
Phase 3: Advanced ACL Rehabilitation (6-12 weeks)
At this stage, most patients are cleared for light resistance work, low-impact plyometrics, and gentle jogging. Swelling should be completely gone by now.
But if you happen to not be there yet, don’t become frustrated. ACL recovery is personal. What’s important is that you stay consistent and focus on what you need. No rushing, give your knee time to heal.
Phase 4: Functional Recovery & Sport Prep (3-7 Months)
If your ACL injury didn’t require surgery, this may be your final phase before returning to sport. Your physical therapist will progress you through an advanced strength and agility program.
So, expect controlled drills like cutting, pivoting, sprint deceleration.
And if you have had surgery, this phase is still a crucial part of preparing your body. You’ll move into the next phase before full clearance.
Phase 5: Final Healing (8-12 months)
This phase usually applies to post-surgical recovery. In this final stage, you’ll continue with sport-specific training, focusing on movements that match your sport. You will still avoid contact drills for another 4 to 6 months.
Even if you feel “back to normal,” it’s important to stay patient. Your ACL is still healing, and the last thing you want is a setback.
How To Heal an ACL Injury Faster and Better
Let’s wrap it up. If your ACL injury was mild and didn’t require surgery, you could be back in 3 to 4 months, depending on your doctor’s evaluation. But for more severe injuries—especially those needing surgery—recovery can take 6 to 12 months.
We have seen the look on many athletes’ faces when they get the news. We know how frustrating an ACL injury can be. The timeline feels long, but the only way through is with patience and trust in the process.
At P1, we specialize in helping athletes recover the right way. Our team of expert physical therapists works with pros, weekend warriors, and anyone serious about coming back stronger.
If you are dealing with an ACL tear, you need expert PT guidance, physically and mentally. And that’s exactly what you get at P1, Utah’s top fitness and wellness center.Book a session with us today, and let’s get you back in the game.