How we test strength at each stage of ACL rehab

ACL reconstruction is followed by a long rehab, usually nine months or more before returning to a sport like football or kabaddi. Patients often ask how we decide when to move on from one stage to the next. The short answer is that time alone does not decide; tests do, always within the surgeon’s protocol.

In the early weeks, we measure how far the knee bends and straightens, how much it is swollen and whether the thigh muscle switches on properly. Before moving to walking without crutches, most patients need a straight knee, a good quadriceps contraction and a normal walking pattern without a limp.

In the middle months, the tests are about strength and control. We record single-leg squats on a box, step-downs and balance on one leg, often on video so you can see the change. We measure thigh strength with a handheld dynamometer and compare the operated leg with the other. Running usually begins when strength on the operated side is around 70 to 80% of the other side, among other checks.

Before returning to sport, we use a series of hop tests: single hops, triple hops and side hops for distance and time, again comparing both legs, along with agility drills and a questionnaire about how confident you feel. We share all the numbers with you and your surgeon. Rahul, a footballer from Bodakdev, kept his test sheets on his fridge, and said watching the numbers improve kept him going on the slow weeks.