The ACL is one of the most devastating injuries an athlete can have in his/her career. It is usually torn as a result of a quick deceleration, hyperextension, or rotational movement that usually does not involve contact with another person. The return to sport after surgery percentage ranges from 75-90 but this return to sport is a reason for contralateral knee injuries and is more common than most athletes think. Research shows a tear of the ACL in the original unaffected lower extremity after return to sport is up to 11%. Some of the factors that have shown to increase the risk of the contralateral tear of the ACL include: 18 years old or younger, return to competitive sports, and the male gender. Furthermore, research shows that return may occur as quickly as 6 months, but most re-tears occur in the first 8 months. It is recommended that return to sport occurs between 9-12 months to prevent the possibilities of re-tearing the graft.

After an ACL reconstruction, it is important to promote early weight bearing and early ROM focusing on knee extension from day 1. It is extremely important to protect the graft and control the effusion in the knee. Quad strength is paramount and quad sets should be done immediately post-op. Closed kinetic chain exercises are done as early as day 3(figure 1) and open kinetic chain exercises are suggested after 6 weeks (figure 2). It’s important to note you can always slow down but can never speed up the progress of the patient because you do not want to re-tear the graft.