Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 12 October 2026.
How long is ACL rehab?
Most people need 9 to 12 months after ACL reconstruction before going back to pivoting sport such as football, basketball, badminton or netball. Walking without crutches usually comes in the first few weeks and jogging around three to four months. Going back to sport is decided by strength and hop tests against the other leg, not by the date.
The nine-month mark is not arbitrary. In the Delaware-Oslo ACL cohort, the rate of knee reinjury fell by roughly half for each month that return to pivoting sport was delayed, up to nine months after surgery, and patients who passed return-to-sport criteria before going back reinjured less (Grindem and colleagues, British Journal of Sports Medicine, 2016).
| Stage | Typical time after surgery | What it works on |
|---|---|---|
| 1. Calm & Protect | Weeks 0 to 2 | Swelling down, the knee fully straight, the quadriceps switched back on. |
| 2. Move & Mobilize | Weeks 2 to 6 | Full bend, walking without a limp, off crutches. |
| 3. Rebuild & Strengthen | Months 2 to 6 | Quadriceps and hamstring strength against the other leg, single leg control, jogging once criteria are met. |
| 4. Return & Perform | Months 6 to 12 | Hopping, cutting and landing, sport-specific work, and return-to-sport testing before clearance. |
Your surgeon’s protocol takes precedence, and meniscus repairs done at the same operation slow the early stages. If you are past six months and still cannot hop on the operated leg, the Stalled Recovery Review measures where it stopped. Every first visit is one 45-minute Assessment & Treatment, $230, nett, no GST.
Physiotherapy after surgery
ACL Reconstruction Recovery Program
The graft is fixed on day one. The knee you can trust on a side-step takes most of a year.
For ACL reconstruction with a hamstring, patellar tendon or quadriceps graft, with or without a meniscus repair at the same time. A staged physiotherapy program run to your surgeon’s plan, at five Singapore clinics.
No referral needed to start. Bring your operation note, discharge summary or scan report.
Start here
Where are you right now?
An ACL knee is a different problem depending on the week you are reading this. Pick the one that matches.
How the program runs
4-Stage Structured Recovery
You move up a stage when you meet the criteria for it, not when a number of weeks has passed. That is Criteria Before Clearance, and it is why the last appointment is a graduation rather than a discharge.
The shape of it
What happens, week by week
The weeks below are the usual shape after a reconstruction. A meniscus repair at the same time slows the early weeks, and graft type changes some of the detail. Your surgeon’s protocol takes precedence over anything on this page, every time.
- Weeks 0 to 2Stage 1 · Calm & ProtectCrutches as your surgeon directs. Swelling down, the knee fully straight, and a straight-leg raise without the knee sagging. A knee that does not straighten in the first weeks is the one that is hardest to fix later, so this is the first job.
- Weeks 2 to 6Stage 2 · Move & MobilizeOff crutches once you walk without a limp. Bend past 90 degrees and on toward the other side. Static bike, step-ups, and early strength work.
- Months 2 to 6Stage 3 · Rebuild & StrengthenStrength, single-leg control and balance. Quadriceps and hamstring strength tested against the other leg. Straight-line jogging usually starts here, once the criteria are met.
- Month 6 onwardStage 4 · Return & PerformHopping, landing, change of direction, and the drills your sport needs. You go back to pivoting sport when the hop and strength tests say so, and not before nine months.
After the operation
Is this normal?
Usually expected
- Swelling that comes and goes with activity for months.
- A thigh that looks visibly smaller than the other side.
- Numbness on the outer side of the scar, especially after a patellar tendon graft.
- Kneeling that stays uncomfortable for a long time.
- An ache after a long day on your feet, settling overnight.
- Clicking without pain or swelling.
Contact your doctor
- Call 995 or go to the emergency department now: sudden shortness of breath, chest pain, or coughing up blood. After leg surgery these can mean a clot that has traveled to the lungs.
- Doctor the same day: a calf that becomes painful, swollen, warm or tender, which can mean a clot in the leg.
- Doctor the same day: fever, or a wound that is red, hot, opening or leaking.
- Surgeon soon: a knee that locks and will not straighten at all, or a give-way with sudden swelling.
- Surgeon soon: a knee that has not reached full straightening by about six weeks.
- Review soon: no change in range or strength over 3 to 4 weeks of therapy.
We would rather send you back to your surgeon early than be the reason you went late.
If it is not going to plan
Six months on, and it still does not feel like your knee
The surgeon is happy with the graft. You are walking, you are back at work, and you still take the stairs one at a time going down.
You avoid the jump in the futsal game. You never quite put your full weight on that leg when you stand. The thigh is still smaller, you can see it in the mirror, and nobody has measured it since week eight.
A knee that has plateaued after reconstruction is usually a strength problem that has been managed as a pain problem. The pain went. The quadriceps never came back. The fix starts with numbers: strength side to side, hop distance, and how the knee behaves when you land on it.
The Stalled Recovery Review is three appointments, one a week for three weeks, with the same physiotherapist. The first finds what is holding you back. The next two measure how it responds, because what a joint does under load cannot be read in one visit. $690, nett, no GST.
More on what the three appointments cover: the Stalled Recovery Review.
Logistics
When can I…
Your surgeon decides, based on healing and what your job demands. These are typical points, not permissions.
| Activity | Typical point | What has to be true first |
|---|---|---|
| Desk work | 1 to 2 weeks | Swelling controlled, and you can get to work safely on crutches. |
| Driving | 2 to 6 weeks | Off strong painkillers and able to do an emergency stop. Right knee takes longer than left in an automatic. Your surgeon agrees, and check your insurer. |
| Walking without crutches | 2 to 4 weeks | Full straightening and a walk without a limp. |
| Jogging in a straight line | 3 to 4 months | Stage 3 criteria met, including strength and a hop without pain. |
| Gym, legs | From week 2, progressed | Within the exercises your surgeon allows, loaded on criteria. |
| Pivoting sport: football, basketball, badminton | 9 months or later | Stage 4 criteria met, including hop and strength tests within 10 percent of the other leg, and your surgeon’s clearance. |
| IPPT (sit-ups, push-ups, 2.4 km run) | Sit-ups and push-ups often well before the run. The 2.4 km run usually 6 to 9 months or later | Hop and strength tests against the other leg, a continuous run built up to 2.4 km without swelling, and your surgeon’s go-ahead. Your unit’s medical officer decides your medical status and when you take IPPT. |
| Medical certificate | Your doctor issues it | Physiotherapists do not issue MCs. We can write a report on your functional limits for your doctor or employer. |
Questions
Questions people ask after ACL surgery
How long is recovery after ACL surgery?
Most people need 9 to 12 months after ACL reconstruction before going back to pivoting sport such as football, basketball or badminton. Walking without crutches usually comes at 2 to 4 weeks and straight-line jogging at around 3 to 4 months. Return to sport is decided by strength and hop tests against the other leg, and by your surgeon.
How long does it take to walk normally after ACL surgery?
Walking without crutches usually comes at 2 to 4 weeks. What has to be true first is a knee that straightens fully and a walk without a limp. Your surgeon’s instructions on how much weight to put through the leg come first.
When can I drive after ACL surgery?
Usually between 2 and 6 weeks. You need to be off strong painkillers and able to do an emergency stop. A right knee takes longer than a left in an automatic car. Your surgeon has to agree, and check with your insurer before you drive.
When can I go back to work after ACL surgery?
Desk work is usually possible at 1 to 2 weeks, once swelling is controlled and you can get to work safely on crutches. Physical jobs take longer and depend on what the job demands. Your doctor issues the medical certificate. Physiotherapists do not issue MCs.
When can I go back to sport after ACL surgery?
Pivoting sport such as football, basketball and badminton usually comes at 9 months or later, once hop and strength tests are within 10 percent of the other leg and your surgeon clears you. In the Delaware-Oslo ACL cohort, reinjury risk fell for each month that return was delayed, up to nine months.
The program
What it costs and what is in it
ACL Reconstruction Recovery Program, Stages 1 to 4
Per 45-minute appointment, nett, no GST. The ACL Reconstruction Recovery Program is 12 appointments, $2,760 in all. You pay for each appointment as you attend it. If you need more, your physiotherapist shows you which stage criteria are still open, and each extra appointment is $230.
- An Assessment & Treatment first, at $230: which stage you are in, what is limiting you, and a written plan you walk out holding
- Swelling and scar care
- Staged range and strength work, progressed on criteria
- Quadriceps and hamstring strength measured against the other leg
- Hop and landing tests before return to sport
- A home program, written down
- A one-page report to your surgeon at weeks 2, 6 and 12 if you were referred
- Your next stage review dated into the diary, with the same physiotherapist
Graduation, Not Discharge. The program ends when you meet the Stage 4 criteria for the sport or work you are going back to.
Who you will see
Managed by our physiotherapy team
ACL reconstruction sits with the physiotherapy team, with the return-to-sport testing done by the same physiotherapist who saw you in week one. You stay with the same physiotherapist through the program, and every appointment is one to one for the whole 45 minutes.
Fairuuz Saleh
Principal Physiotherapist at Tampines. Post-operative ACL reconstruction and return to sport, hip pain including labral tears, and knee rehabilitation.
This program runs Stages 1 to 4 of the Phoenix Recovery Protocol. It sits under physiotherapy after surgery, alongside the other recovery programs.
Sources
Where the numbers on this page come from
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine, 2016.
Timings on this page are typical ranges, not predictions for any individual recovery, and your surgeon’s protocol takes precedence. Physiotherapists assess, treat, exercise, educate and refer; doctors diagnose, inject, prescribe and order imaging. If we find something that needs medical review we refer you back to your doctor.
What is the anterior cruciate ligament of the knee?
The anterior cruciate ligament of the knee is one of the four ligaments of the knee, and this particular one sits deep inside the middle portion of the knee.
It is extremely important as it
- controls the stability of the knee
- prevents the lower leg from sliding too far forwards
- prevents over-twisting of the knee
The ACL is
- 2 cm long
- as thick as a pencil and
- extremely strong and durable
What is an anterior cruciate ligament Tear?
An ACL knee injury happens when the anterior cruciate ligament is stretched beyond its ability to stretch (typically due to the knee bending backwards too much or twisting awkwardly).
These cause:
- Partial ACL Tear where only some of the ligament fibers are torn or
- ACL Full Rupture where the ACL ligament tears completely
The ligament can be stretched just below 2 mm before it will tear. In some cases, patients may also damage nearby other structures such as knee cartilage or the knee medial collateral ligament as well at the same time they injure their anterior cruciate ligament.
But what causes an ACL knee injury?
An ACL knee injury can happen due to direct contact with the knee or from an awkward movement, usually with the foot is fixed to the ground e.g. eg when wearing studs or cleats
Non-Contact Injuries
As mentioned earlier, non-contact injuries account for 80% of all knee anterior cruciate ligament injuries and are caused by:
- Twisting the Knee: such as very quick pivoting or changing direction
- Landing Awkwardly: from a jump or a fall
- Hyper-Extending the Knee: when the knee bends the wrong way by more than 10° causing it to gap and over-stretch at the back of the knee
- Sudden Deceleration: coming to an sudden stop/standstill whilst the foot is firmly planted
Contact Injuries
Contact injuries only cause 20% of all ACL knee injuries and are typically due to a force to/at the side of the knee with the foot is firmly planted to the ground e.g. with studs which then forces the shin bone to move either too far inwards or backwards
An ACL knee injury can also occur at other times by
- motor vehicle accidents
- falling or
- even from wear and tear
Gender Effect
So while knee anterior cruciate ligament injuries seem to occur in many men, this is simply because more men simply play higher risk sports (this will change as more and more women play higher risk sports) BUT more important to note is:
Studies are showing that women are at greater risk of up to 500% chance to suffer from a knee anterior cruciate ligament injury as compared to men.
The supporting thoughts and studies point factors such as
- hormone levels
- ligament structure
- pelvis Q angle
- hamstring flexibility
- size of the ligament itself
What are the common symptoms of anterior cruciate ligament injuries?
The most common ACL symptoms experienced with injury are:
- Audible Pop: approximately 50% (1 in 2 incidences) of the time there is a popping or cracking noise at the time of injury when / with ACL ruptures
- Knee Swelling: usually immediately, in less than 2-6 hours, and extensive swelling with full ruptures. But if it’s only a small anterior cruciate ligament tear the knee swelling may develop a few days later or it may not even swell much if any at all. Swelling occurs due to damage to the blood vessels inside the knee – and this is termed as haemarthrosis.
- Knee Pain: typically there is immediate knee pain after an ACL knee injury especially when you put any load/weight on the leg/through the affected knee or when you try and bend the knee.
- Instability / Buckling: the injured knee will often seem or feel like it’s unstable and can give way or buckle anytime. If the ACL has completely 100% torn, this knee instability will unfortunately be an ongoing problem until/unless repaired surgically.
- Decreased Range of Movement:knee movement is often decreased after an ACL knee injury, particularly knee extension. This is termed as extension lag, where the knee heals with a slight flexion.
Diagnosing a knee anterior cruciate (ACL) ligament Injury
A sports or orthopedic doctor can usually accurately diagnose an ACL knee injury by doing a couple of clinical examination.
The most common tests used are the
- Pivot Shift
- Anterior Drawer and
- Lachmans Tests
Doctors will confirm their diagnosis of ACL tears by ordering an MRI imaging which will also show if any other structures in the knee have been damaged as well.
Associated knee Injuries
Typically with knee ACL injuries, the force that injures the ACL will often be strong enough to also damage other nearby knee structures as well.
The most commonly injured structures together with ACL are:
- meniscal / meniscus tear, which is the special cartilage which lines the knee joint. A tear of the lateral meniscus on the outer side of the knee is most common with an ACL knee injury.
- medial collateral ligament can also be damaged.
In some unfortunate circumstances, it is possibly to have ALL THREE structures injured, known as the Unhappy Triad / O’Donoghue Triad. It’s most common when the knee ACL injury comes from a force through the outer side of the knee when the foot is fixed on the ground.
Anterior cruciate ligament Treatment Options
Treatment of an ACL knee injury will depend on a combination of things:
- severity / degree of injury
- level of knee instability
- lifestyle of the individual
ACL injuries are managed either surgically or conservatively (without surgery) with good knee physiotherapy program.
Immediately after an ACL knee injury, the best thing that patients need to do is follow PRICE principles –
- Protect
- Rest
- Ice
- Compression and
- Elevation
Then, there are two treatment options:
1) Knee Physiotherapy & Rehab (Recommended)
This approach is typically recommended especially
- if there is little to no knee instability
- if there is no severe knee pain
and what our knee physiotherapists in Phoenix Rehab Singapore will do for patients with partially or completely torn anterior cruciate ligament injuries is to build up the strength of the knee muscles so that they provide enough support and stability for the knee to compensate for the torn ACL.
We will also train the muscles and other ligaments to provide proprioceptive feedback to gain more stability.
Typically it takes a few months of knee ACL physiotherapy to fully recover conservatively from an ACL knee injury.
2) ACL Knee Surgery
Corrective knee ACL surgery is recommended if the knee is very unstable and keeps unbuckling. This is important as each time the knee buckles, it’d damage other structures in the knees, such as the knee cartilages and knee meniscus.
It is important to avoid repeated buckling of the knee because if the meniscus tears, there is less protection for the knee bones and increases the risk of developing knee arthritis.
Of course, falls can cause other issues such as concussions and fractures such as wrist fractures, hip fractures, back and neck (spine) pain and more
Corrective ACL surgeries is recommended / indicated in patients who:
- Want to go back to pivoting type sports such as football, skiing, tennis, rugby, hockey – any sports with a lot of knee pivoting
- Have problems with the knee giving way during their everyday activities
In some patients the ACL cannot be repaired, and instead the ligament is replaced with a surgery procedure called knee anterior cruciate ligament reconstruction.
Why Is our knee anterior cruciate ligament So Important?
Our ACL ligament in the knee has two (2) core functions:
- protects against abnormal knee movements
- provides knee proprioception
Proprioception is a special feedback system that allows you and your body to know where the knee is in space and in movement (this is common in all healthy joints).
An example of joint proprioception is simply closing your eyes and trying to locate your knees with your hands or trying to move your knees – it’s easy when your proprioception is normal. Proprioception lets you know where your joints are and what they are doing and how they are moving.
So our anterior cruciate ligament is responsible for knee proprioception, which helps to control and influence reflex control of the knee and its movements. This allows our knee to stay and keep stable without having us to keep actively being aware of it (ie autopilot knee stability).
Without knee proprioception, your body will not know how to adjust the knee position especiall with movement, in changing direction or when on uneven ground…leading to even more knee sprains.
With an ACL knee injury, this loss of proprioception can be compensated to a certain degree, with specific knee proprioception physiotherapy exercises for the knee muscles. BUT for people who have a high demand / need for proprioception e.g. those who play sports, this may not be enough.
Preventing knee anterior cruciate ligament Injuries
Prevention is always better than cure, especially in the case of knee ACL injuries due to the possibility of long term knee pain, knee instability, recovery time etc.
We can help provide focused knee physiotherapy for your ACL injury.
References
Where are you with this right now?
1. It is settling on its own
Most knee pain that started with a specific moment settles over six to twelve weeks. Swelling that comes and goes with activity, and an ache after a long day, are usual in that window. If it is improving month on month and you can walk, take stairs and sleep, it is behaving normally. You do not need us for this, and we would rather say so.
2. It has stopped improving
You go down stairs one leg at a time. You have stopped squatting to pick things up. You test it before you trust it.
Pain settling is the first thing that happens, not the last. Quadriceps strength is the last thing to come back, and it does not come back on its own. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the ACL Reconstruction Recovery Program, or knee physiotherapy if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
Related reading
- Netball injuries
- Rugby injuries
- Football injuries
- physiotherapy after surgery
- knee physiotherapy
- Knee Pain Location Chart: Understanding Discomfort Sources
- Dealing with Knee Pain When Bending: A Comprehensive Guide
- Knee meniscal tear physiotherapy
- The Phoenix Recovery Protocol, and the four stages
- All recovery programs, hand and physio
- Dislocated kneecap
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