Running after ACL surgery

A common question we hear at the beginning of ACL (anterior cruciate ligament) rehab is “how long until I can run again?” To answer that we need to dive into it a bit further.

It is usually well understood that return to play in sport can take anywhere up to 9 months – 12 + months depending on a number of factors, but straight-line running expectations seem to be less widely communicated and good news, it can start a lot sooner.

However before we ask “how long”, a better question should be “what do I need to be able to do before I can run” as returning to running should be more criteria based rather than time based (and returning to sport is no different when we look at that too).

Finding a way to keep fit following ACL surgery can be a bit challenging. Swimming to some extent can be tested once the wound has fully healed. Cycling typically can be tested once patients are able to manage a knee bend of over 105 degrees which usually takes anywhere between 4 weeks – 3 months. With running it is a little more complicated.

Before going into the criteria – it is worth mentioning the average time it takes to tick these boxes is 12 weeks post-surgery. Anywhere between 10-16+ weeks is a normal range though and it is based on pain, swelling, movement, strength, power and control as well as being psychologically ready to return to running.

Pain will fluctuate after surgery and to be ready for running, pain should typically not exceed a 2 out of 10 pain scale score.
Swelling must no longer come and go in day-to-day life. This may take time.
Movement in the knee needs to match the unaffected limb by 95% when measured. This will improve with exercises.
Strength will be measured in a number of ways and must match the unaffected side by 70% . Research suggests 30 step ups and 10 single leg squats supervised with enough depth (45 degrees) and good knee control. Verified balance tests must also show a 90% match for control to be considered good enough for running.
can be assessed with verified vertical and horizontal hop tests and this must match the unaffected leg by 85% before it is considered ready for running.
Verified questionnaires may be carried out by physiotherapists to determine how psychologically ready you are for running.

The time taken to achieve this off will vary due to the surgery’s graft type, the age of a patient, fitness and strength of a patient pre-op, the overall health of patients and genetics.

Be patient with the rehab and the running can start to build up again soon!

Alexandre J M Rambaud, Clare L Ardern, Patricia Thoreux, Jean-Philippe Regnaux, Pascal Edouard, Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review Br J Sports Med, 52 (22), 1437-1444.

Ardern CL, Taylor NF, Feller JA, et al. Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med 2014;48:1543–52.

Ardern CL, Glasgow P, Schneiders A, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med 2016;50:853–64.

Rambaud AJM, Semay B, Samozino P, et al. Criteria for Return to Sport after Anterior Cruciate Ligament reconstruction with lower reinjury risk (CR’STAL study): protocol for a prospective observational study in France. BMJ Open 2017;7:e015087.

Takeda K, Hasegawa T, Kiriyama Y, et al. Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks. J Biomech 2014;47:2526–30.