Recovery after ACL reconstruction: stage by stage

The figures below come from NHS trust patient leaflets and are typical ranges. Your graft type, any meniscus repair and your surgeon's protocol can change them. Treat the table as a guide to what usually happens and use your own written plan as the rule.

Cambridge's protocol notes that from about twelve weeks progress is criteria-based rather than time-based, which is a useful way to think about the whole recovery: you move forward when the knee can do the next thing, not simply because a week has passed.

Leeds describes pain, swelling and bruising extending through the thigh, knee and leg as normal early on. Ice and elevation are used to settle swelling in the first weeks, and swelling can come and go for longer when you do more.

Keep the dressings clean and dry until you are told otherwise, and expect two areas of wound: the knee portals and the small cut where the graft was taken. Numbness beside the graft scar is recognised.

The Cambridge leaflet advises that if exercise leaves the knee hotter, more swollen or more painful, you should cut back, use ice and elevation and ask your physiotherapist.

The Leeds leaflet says driving is permitted around three to four weeks, but only once emergency stops are manageable. The legal responsibility is yours: the GOV.UK pages advise asking your doctor if you are unsure and tell you to inform the DVLA if you are still unable to drive three months after an operation. Your insurer's terms and your ability to control the car both matter.

Return to office work is described as possible about two to three weeks after surgery. A physically heavy job will need longer, and your surgical team will advise on the timing for your own role.

• Elevate the leg when resting through the first fortnight.

• Use the stairs sensibly and keep both crutches until you are told to stop.

• Plan short outings while the knee tires easily.

Hamstring-graft patients are told to avoid resistance in open-chain hamstring exercises until twelve weeks, with non-resisted work from about week four; patella-graft patients can start controlled resisted leg extensions from week four in a limited range. The graft type therefore matters to the programme.

Return-to-sport criteria in the Cambridge leaflet include no giving way, thigh strength within 10% of the other side, hop tests within 10% and psychological readiness. Cambridge says six months is the earliest and nine months is recommended; Leeds sets nine months for adults over 18 and twelve for under-18s.

Physiotherapy starts on the ward and continues as an outpatient programme, and Leeds describes up to a year of rehabilitation in three progressive phases. Your surgeon may also review the knee at a few weeks and again later, so keep these appointments and take written exercise sheets along.

• Fever, chills, or redness spreading from a wound: contact the hospital or NHS 111.

• A hot, swollen, tender calf, chest pain or breathlessness: emergency help, 999 if severe.

• The knee giving way, locking or suddenly swelling after a twist.

• Numbness that spreads, or a foot that turns pale or cold.