Recovery After ACL Injury

https://pmc.ncbi.nlm.nih.gov/articles/PMC12582240/

Evidence base

Ridha A, Raj S, Searle H, Ahmed I, Smith N, Metcalfe A, Khatri C. The recovery trajectory of anterior cruciate ligament ruptures in randomised controlled trials: A systematic review and meta-analysis of operative and nonoperative treatments. Knee Surg Sports Traumatol Arthrosc. 2025.
https://doi.org/10.1002/ksa.12626

This study was conducted by our team to better understand how patients recover over time after ACL injury, with or without surgery.

Key points

  • Both surgery and rehabilitation lead to significant improvement after ACL injury
  • Most recovery occurs in the first 6 to 12 months
  • Improvements continue up to around 2 years before plateauing
  • Some patients can achieve excellent outcomes without surgery
  • Surgery remains important for those with instability or high sporting demands

Why is this important?

An ACL rupture is a common knee injury, particularly in active individuals.

Traditionally, surgery has been considered the standard treatment. However, many patients can also do well with structured rehabilitation alone.

This study, performed by our research group, helps clarify how recovery progresses over time and whether surgery changes that trajectory.

What did the study involve?

This was a systematic review and meta-analysis of randomised controlled trials.

It included:

  • patients treated with ACL reconstruction
  • patients treated with structured rehabilitation

Outcomes such as pain, function, and activity level were measured using validated scores across multiple time points.

By combining data from several trials, the study provides a clearer picture of recovery patterns.

What does recovery look like?

The overall recovery pattern was similar in both groups:

  • Rapid improvement in the first 6 months
  • Continued gains up to 12 to 24 months
  • A plateau phase after this

This suggests that the body has a strong natural recovery capacity following ACL injury, supported by rehabilitation.

Surgery vs non-operative treatment

ACL reconstruction

  • Provides mechanical stability to the knee
  • May be beneficial for patients returning to pivoting or high-demand sport
  • Follows a similar recovery trajectory to rehabilitation

Rehabilitation alone

  • Can lead to excellent functional outcomes in selected patients
  • Avoids the risks associated with surgery
  • Requires commitment to structured physiotherapy

What does this mean for you?

The key message from this study is that both treatment options can be effective.

The decision between surgery and rehabilitation should be based on:

  • your activity level and sporting goals
  • symptoms of instability
  • associated injuries
  • personal preference

For some patients, rehabilitation alone is sufficient.
For others, particularly those returning to high-level sport, surgery may be the better option.

Key considerations

  • Recovery after ACL injury takes time, often 9 to 12 months or longer
  • Early improvement is expected, but full recovery continues beyond a year
  • Not all patients require surgery
  • Treatment should be tailored to the individual