Ask Dr. Geier – Running after ACL surgery

Hi everyone! Thank you as always for all the great questions you send. While many of you use the Contact form on this site (which is great), please know that you can also use Facebook or Twitter. If you want to ask a question on Twitter, as Courtney did below, make sure you mention me so that I will see it. And I will do my best to answer it there or in an Ask Dr. Geier column or on The Dr. David Geier Show.

As always, please remember my disclaimer that I cannot and will not offer specific medical advice on my blog, on my show, on my social media pages, or by email.


Courtney Sanders asks on Twitter:

Hey! @DrDavidGeier just found out I have been running w/o an ACL for almost 10 yr and now have torn meniscus and arthritis stage 3. Will I run pain free again?!! I’m only 26. ;(

Thanks for the question, Courtney!

That is actually a more complicated question than you might think. First of all, it is certainly possible to run without an ACL. Sports like soccer, football, or basketball that involve rapidly changing directions, twisting, cutting, and landing from jumps are next to impossible without an ACL due to rotational instability. Running, however, is a forward motion. I have known several runners in their thirties who decided not to have surgery and were able to run without much change.

Having said that, if an athlete, even one who doesn’t play a cutting or pivoting sport, is having the knee give way or buckle, we usually recommended surgery to reconstruct the ACL. And having a meniscus tear probably makes sports medicine surgeons more inclined to treat the knee surgically, as the pain from the meniscus tear usually limits the patient’s activity. These are generalizations, so much of the decision is based on the specific symptoms.

Running on trailAs far as returning to sports and exercise after ACL surgery, it is a long process. As I have described elsewhere on this blog, the rehab process involves 5-6 months of physical therapy. First the patient and therapist work to restore full knee range of motion and then lower extremity strength. Gradually the therapist will allow the patient to start some exercise, such as stationary biking and then possibly an elliptical trainer. Jogging is usually withheld for 10-12 weeks to avoid repetitive stress on the ACL graft. Roughly around three months after surgery, the patient starts more functional training that involves plyometrics, balance, proprioception, and other skills that will get the athlete back to sports successfully.

Now unfortunately nothing is ever guaranteed with surgery, and that fact is especially true after ACL surgery. While most sports medicine surgeons do feel that return to sports is likely, there are some recent studies that show return-to-sports numbers closer to 60-70% instead of the 90% or so that we usually cite. I will discuss this data in an upcoming post, but many factors might be involved. Most important to these lower return-to-sports numbers seems to be psychological factors and apprehension about reinjuring the knee. Now these issues might not be as important in returning to jogging, which does not involve rapid twisting and landing from jumps. But it still must be remembered that return to a sport at the pre-injury level is never guaranteed.

Lastly, the presence of a meniscus tear and arthritis changes can be important. What specific treatment is needed for the meniscus can have a large effect. Most meniscus tears cannot be repaired (meaning sewn back together). The vast majority of meniscus surgeries involve trimming out the torn part, as the tear configuration and location is such that a repair would not heal. In theory, removing some of the meniscus, which acts as a shock absorber in the knee, could lead to arthritis changes down the road.

Also, the presence of arthritis changes at the time of surgery could suggest that the athlete will have some pain even after he or she has returned to full activity. As we have talked about in other posts, surgeons can look at the degenerative changes to the articular cartilage and try to smooth them out with a shaver. But this does not restore them to normal cartilage. While we have some treatments that might help small areas of cartilage damage, we have nothing reliable that reverses more diffuse changes back to normal cartilage. That doesn’t mean that the athlete cannot run, but it is important in a long-term sense.

41 Responses to Ask Dr. Geier – Running after ACL surgery

  1. Hi Dr. Geier,

    Thanks so much for your response to my questions. I had my ACL reconstruction and meniscus repair surgery on Friday! Have gone to PT once and am using the game ready ice system. I am really going to dedicate myself to PT for the next 6 months!!

  2. Good luck with your rehab!
    I had my ACL reconstruction done two weeks before my 21st birthday due to a wrestling injury. After rehab I started running and two years later ran my first 5K in 19:41. That was 13 years ago and now I am training for a half marathon in August. I thank Senator Bo Watson for helping coach our wresting team and my rehabilitation.

  3. Thank you for your valuable comments. I had meniscus surgery and acl surgery last year. Is there a brace you would recommend to wear while running? I’ve looked on-line and there are so many types, but I hate to spend the money trying them out. I just wish I had something to sturdy the knee while running that was more than an elastic type band.

    • Generally no brace limits the twisting movements that typically cause meniscus tears. And since the knee isn’t inherently unstable after surgery to trim out part of a meniscus tear, most orthopaedic surgeons don’t require patients to wear braces. Having said that, some people feel that knee sleeves or fancier versions of that provide a sense of stability and help them return to sports and exercise.

      • Thank you for responding. Although my last surgery for the acl was last mid-July, I feel apprehensive about putting weight on my knee to run. I walk and bike ride just fine. I’m just worried about the pressure. Maybe it still needs more time and strengthening. Thanks again.

  4. Dr. Geier,
    I am 22 and had MCL reconstruction and meniscal repair 8 weeks ago. I have rehab protocol for 2x/day and seem to be progressing fast (full range of motion, body squats, brisk walking with no limp, etc.). I’m currently biking with resistance once a day as part of my rehab program and am curious if you have had a similar case-male in low 20’s, and how soon that patient began running again.

    • Fortunately I have rarely had to perform MCL reconstructions as they heal on their own or just need a primary repair. I tend to hold patients who underwent a meniscal repair out of jogging for about 4 months, assuming everything is going well. I have concern that the repetitive impact from running could disrupt the healing of the meniscal repair. Having said that, the time is only one factor among many and have to be tailored to the particular patient and the surgery he or she had.

  5. Hi I’ve recently had acl on my right knee. They used the pletellor tendon graft I had it on the 10th of January .. When I pull my leg (below the knee) forward and back there’s still a lot of movement ! I just want to know if this is normal because I’m itching to start running and would love to be able to have kick abouts with friends ..

  6. Hi,

    I had an ACL reconstruction in November last year. I got a staph infection, had three wash out surgeries to remove it. Then had a drip in for two weeks and was on antibiotics for a month.

    I’ve been doing gym exercises and just started running.

    However recently i’ve been having problems with my feet swelling right on the bottom. Tonight my knee is really sore just above my knee cap, sore even to touch. Feels like bruising maybe?


    • Sorry. I wish I could help, but without seeing you formally as a patient, I can’t really know the cause of your symptoms or give you any advice.

  7. Hy Dr..
    This kunu.I did ACL surgery 1 year back,As per my doctor advice i did so many exercise.I always love to run but after 1 year when i start jogging i am getting pains in my knee(surgery knee).My questing is tht when i can start run as before and how much time to take relief from this pain and injury.Pls replay me.Your advice is very important to me.

    Thanking you

    • Pain in the front of the knee can occur after ACL surgery, especially when the patient has not regained all of the strength of that lower extremity. Getting back into physical therapy can often help return to full activity. Your surgeon could give you more specific advice about anything else going on in your case.

  8. Hello Dr. Geiger,
    I am 31 yr old guy. I torn my ACL 3 yrs ago and had my surgery done (Hamstring graft). There was no meniscus tear or any other complications. I did physio and proper weight training and I never had any pain in the knee.
    I am currently getting into the long distance running and I usually run 12-15 km 3 times a week and there’s no pain. My question is; Is it okay if I go train myself for a marathon or that sort of long distance running? I see many doctors say that when I had my ACL done, I am already having an arthritis risk. They also say that if not now but I might get it after say 10-15 yrs. I wonder, I am completely fine now and don’t have any issues with the knee. If I control my weight and build muscle mass in the lower body, will I still be at the risk?

  9. I had ACL reconstructive surgery on March 12th 2013 and am worried that I’m still unable to jog. I went to PT for the first 3 months after surgery and have since been riding my bike diligently 15 miles per day. I have strengthened my quads and other muscles in my legs and have regained full range of motion. I can walk normally without feeling any pain, however, I can’t jog at all. I can’t bare the pain from the impact when I land (even from a slow jog). I am 5 1/2 months out of surgery and am worried that my ACL didn’t heal correctly, or even worse, failed entirely. Are there such cases? Is it normal not to be able to job (even at a slow pace) at 5 months post surgery?

    • Yes it is possible, although I can’t say if that is normal in your case. Your orthopaedic surgeon can examine your knee and review any necessary radiology studies to tell you if something worrisome is going on that is causing your issues with jogging.

  10. Hi, I’m 19 and play soccer at a high level I had an ACL reconstruction and meniscus repair over 2 years on March 29th 2012 ago a year later after my surgery I ruptured my ACL again causing my meniscus to get fully torn. I had a emergency surgery to remove the meniscus and only a week ago I have just had my second ACL reconstruction using a donor ligament grath. I have been told by my surgeon to give up on soccer as I’ll never be able to get back playing again and the ACL might not hold, I would love your opinion if you think it’s possible for me to get back playing again I have gone round to different sports specialist to see what everyone’s opinion is to help me decide what to do.

    • It is hard for me to give specific information or predictions without being involved. While it can certainly be more difficult to return to sports after a second ACL surgery than a primary one, many athletes can do it. The need for meniscus surgeries can be a complicating factor as well, though.

  11. I am 76 years old,completely tore my ACL & damaged my medial mensicus, in a turning/twisting movement. playing a game of cricket, 45 years ago. I opted NOT to go the surgery route but focus on exercise therapy.I am a regular distance runner, all of these years averaging 200 miles a month. Have run uphill/downhill, for years running up 12 floors at a single run.Have been extremely consistent with my knee exercises, have faced no major problems, a couple of occasions post injury, slight knee instability was experienced but these quickly disappeared with rest, followed by return to active knee strengthening exercises. Have been taking part in competitive road races, recently won the Gold Medal in the Sunfeast World 10 k, held in my city, with a personal best timing of 69 minutes, an overall rank of 1040, out of a total field of 8000 runners of all age groups.I believe that the regular knee strengthening program has been a major contributor.

  12. i had ACL reconstruction surgery (right knee) last year on 05 jul 13. i can walk without pain and have regained full ROM. still the operated leg is thinner then the normal leg. i am constantly doing the exercises but still there is no muscle gain in the operated leg. i have not started running till now and when i try to run then slight pain is there around knee cap. what should i do so that i can get back to running or should i wait till the mucles are developed ?

    • I’m not sure I can give you advice. A physical therapist might be able to get you headed in the right direction.

  13. Hi! I’m getting ACL/ LCL reconstruction later this month. I already had ACL reconstruction August 2013 and retore my ACL May 2014. My surgeon said my ACL possibly failed because I had a damaged LCL and this time they are both being repaired with a cadaver. My surgeon told me I will be able to return to basketball 8 months post-op. I was wondering if my recovery timeline will be similar to my first ACL reconstruction. Such as walking around 3 weeks. Running at 3 months. Jumping at 4 months. Will all of this remain the same accept my time to return playing is pushed back? Or will all of these change?

    • I can’t really say, but those are good questions for you orthopaedic surgeon. Often return to certain activities and sports can be slower in the setting of a revision ACL reconstruction or a combined ligament procedure.

  14. Hey Doctor,

    I had ACL reconstruction surgery Febraury 11 of this year. There was some meniscual damage and slight LCL sprain but surgery was not needed for either of those. My recovery has been slower than expected with multiple draining a of my knee and cortisone shots. As of now I have been diagnosed with edema in the bone causing deep pain. My question is, now that I’m basically six months out shouldn’t I be running with no pain by now? Or even just not be having pain on a normal basis anymore? And will I ever run with no pain again? *** I am a huge runner and did XC and track before the injury ***

    • I can’t really say specifically in your case, but I think those are all reasonable questions to ask your surgeon. Generally if surgery and physical therapy are progressing well, most orthopaedic surgeons start patients jogging around 3 months out from surgery, although it is not normal at that point. Return to full motion, strength, and function can take 6-12 months or more. Good luck! I hope you get back to running!

  15. I m 28 and i had acl resonstructiom and meniscus Repair on april, 10 weeks ago.I would like to start trainning for a half marathon on octuber i had been running short distances (2,3 miles ) since week 8 with no paín what do you think?

    • I think many surgeons have different views on when it is safe to run after either in Lisco repair or ACL reconstruction. I typically wait 10 to 12 weeks before allowing a patient to start jogging.

  16. Hi,

    I’m 28 and tore my ACL skiing in March. I had it repaired in May at 8 weeks post injury. At scope I had a crush injury to my posterior meniscus and a completely torn ACL. I had a hamstring graft reconstruction.

    I have made good progress with Physio and had SYbex testing today, my operated knee was about 95% strength of my dominant leg and hamstring strength 48% of my quads.

    I was told I could finally return to running. I have just been on my first run and only did a third of my pre op distance, but, after 200metre I had a sharp pain in my knee. It wasn’t anterior, more medial/posterior.

    I know you can’t advise without consultation, but, do you think it’s just I need more time or could it be I’ve told my meniscus in rehab?

    Thanks for any advice

    • I can’t really say specifically, as you mention. I think that if there is ever a concern that a patient might have reinjured her knee, it can be a good idea to have the orthopedic surgeon evaluate her and potentially order any necessary tests. Having said that, in the early sessions of running after an ACL surgery, discomfort is not uncommon. It can be acceptable occasionally to try it a few times to see if it gradually improves.

  17. I meant to write :

    I have a 26 mm oblique longitudinal tear within the periphery of the posterior horn of the medial meniscus extending to the inferior articular surface too big to be repaired ? Is that considered as a root tear ? (asking the question as I understand trimming this tear can be similar to a total menisectomy. Is it correct ?)
    I had this tear at the same time as an ACL tear . I am getting knee reco next week – 4 months from injury. Is there a chance of this tear being repaired rather than trimmed based on the time from injury (4 months), my age : 43 and the fact that it is being done as part of a knee reco ?
    I met 3 OS and one say it can’t be fixed and 2 other say that they will try to fix it as it is important to do so.

  18. Hi Dr. Geier-

    I’m a 43 yr old physically active female. I had ACL reconstruction with a cadaver graft in April. All seems to be going fine. In the past couple months, I’ve gotten back into running. Today, when I tried to push myself a bit, I felt some instability in my surgery knee and stopped running and it then felt fine. Is some instability during strenuous running normal 6 months post op? Thank you!!

    • Feelings of weakness or instability can be normal in the early months after ACL reconstruction as patients often still lack full quadriceps strength.

  19. Hello I had a acl right knee injury in September in 2014 from football and want to know what kind of running I can do at this point. Also how can I build my muscle tone back in the injury leg?

    Thank you
    D. Jones

    • Generally most orthopaedic surgeons and therapists allow straightforward jogging 3-4 months out from surgery. Closed-chain exercises like squats and leg presses can also help regain lower extremity muscle strength. Your surgeon and PT can give you more specific advise.

  20. I tore my acl last january 11 and I had surgery on february 6..I started rehab 2 weeks post surgery since I did not get any advice from my surgeon about when to actually start. and I was really concerned since most surgeons advise that rehab is supposed to start IMMEDIATELY following surgery..I’ve been in rehab for 3 weeks now and I’ve achieved 120 degrees flexion and close to full extension..I still experience pain only when going down stairs..for some reason,going upstairs is easier..So is it ok if my rehab was delayed for 2 weeks?..should I be concerned?..and is my progress delayed as a result?

    • Many orthopaedic surgeons like to start PT within 4 or 5 days of surgery, but some others will wait 1-2 weeks. As long as the patient makes appropriate progress, waiting 2 weeks might not become a problem.

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