Tore your ACL and have surgery scheduled? Here’s some good news: what you do between now and your reconstruction surgery can make a massive difference in how quickly you get back to running, lifting, or whatever keeps you moving.
ACL physical therapy—often called prehabilitation—prepares your knee for surgery by reducing swelling, restoring mobility, and building strength in the muscles surrounding your injured knee. Think of it as giving your body the best possible foundation before the big event. Incorporating early mobility work such as gentle range of motion drills helps improve both knee flexion and extension before surgery.
What Is Pre-Operative Rehabilitation for ACL Reconstruction Surgery?
Pre-operative rehabilitation is structured physical therapy you complete after your ACL tear but before your anterior cruciate ligament reconstruction. Your physical therapist focuses on calming down inflammation, improving range of motion, and strengthening key muscle groups—particularly your quads and hamstrings—so you head into surgery with a stable, functional knee rather than a swollen, weakened one.
Why Do You Need Physical Therapy Before Your Torn ACL Surgery?
Your knee doesn’t respond well to being immobilized and inflamed for weeks before surgery. Without intervention, you’ll likely experience muscle strength loss, limited knee extension and flexion, and persistent joint effusion (swelling inside the knee joint).
ACL prehabilitation addresses these issues head-on. Research shows that patients who complete pre-operative PT before ACL reconstruction surgery experience better postoperative outcomes, including faster return to sport and improved function. You’re essentially stacking the deck in your favor by achieving what sports medicine professionals call a “quiet knee”—minimal swelling, full or near-full extension, and restored knee function. Targeted knee extension exercises also support achieving that “quiet knee” by improving mobility and muscle control.
How Does ACL Prehabilitation Improve Postoperative Outcomes?
Pre-surgery PT builds quadriceps strength and hamstring strength before surgery, which helps maintain the limb symmetry index—the comparison between your injured and uninjured leg. Stronger muscles before surgery mean less ground to make up afterward, directly impacting how quickly you progress through ACL rehabilitation post-surgery.
What Does ACL Rehabilitation Look Like Before Anterior Cruciate Ligament Reconstruction?
Your pre-surgery program targets three primary goals: decrease swelling, restore full range of motion, and rebuild strength around your knee joint.
How Do Physical Therapists Decrease Swelling and Joint Effusion?
Your PT will use techniques to control swelling and decrease joint effusion, including elevation protocols, compression strategies, and gentle movement patterns that promote fluid drainage without aggravating the anterior cruciate ligament injury. Gait training also plays a role—learning to walk with proper mechanics takes stress off your knee and prevents compensation patterns. Your therapist will assess your weight bearing tolerance and adjust activities to support tissue healing.
What Exercises Help Improve Range of Motion and Quadriceps Strength?
Expect exercises like seated knee extension, quad sets, and gentle stretching to restore movement. Closed chain exercises—movements where your foot stays planted like squats or leg presses—build functional strength while protecting your knee. Balance exercises and neuromuscular training improve stability and coordination.
Your therapist will incorporate prehabilitation exercises that mimic movements you’ll need post-surgery, making that transition smoother. If you’re getting a hamstring autograft for your reconstruction, your PT will adjust the program to account for where your surgeon is harvesting tissue.
How Long Should You Do Pre-Operative Rehabilitation Before ACL Reconstruction Surgery?
Most people benefit from 2-4 weeks of prehab before surgery. Your pre surgery goals include achieving full or near-full extension, minimal swelling, and the ability to perform basic strengthening exercises with good form. Your orthopedic surgeon and physical therapist will coordinate to determine the optimal surgery timing based on your progress.
Getting Started with ACL Pre-Surgical Physical Therapy at Bull City PT
At Bull City PT, we understand you’re not just trying to fix a knee—you’re trying to get back to training, playing sports, or keeping up with an active lifestyle you’ve worked hard to build. Our team takes a personalized approach to ACL rehab, recognizing that your injury, your goals, and your movement patterns are unique to you.
With locations throughout the Triangle in Durham, Brier Creek, Charlotte, and Cary, we make it convenient to start your prehab program immediately. Thanks to Direct Access laws in North Carolina, you don’t need a referral to begin physical therapy—you can schedule directly with us and get started on building the strongest possible foundation for your recovery.
Ready to give yourself every advantage before surgery? Reach out to Bull City PT and let’s get your knee ready for what’s ahead.
