week 1 · last reviewed 2026-06-05
ACL recovery: week 1
Clinical procedure: ACL reconstruction.
Typical, evidence-anchored estimate only. It is not medical advice, not a prediction for your body, and not a substitute for your surgeon or clinician.
what's typical at week 1
typical pain · week 1
Around week 1, the typical pain band sits at 3.5/10 (range 2.5–4.4). This week was measured directly in the cited cohort.
weeks 0–2
Weeks 0-2 · the worst pain is the first 24 hours
Day one is the worst day. The BPTB-vs-hamstring RCT measured VAS pain at six-hour intervals: 5.2/10 at six hours post-op, 4.4 at twelve hours, 3.6 at eighteen, 3.5 at twenty-four, and 2.1 by forty-eight hours. The hamstring arm tracked almost identically. The BJMP daycase study, which followed people daily for a week, reported worst daily NRS of 4.1 on day one falling to 2.5 by day seven. So the rough shape is: very acute first day, sharp decline over the next three to four days, and a slow settle through the second week.
Modern MOON guidelines have you full weight-bearing from day one, with crutches used for balance and confidence rather than offloading. There is no brace in most contemporary protocols. The single hardest motor task in this window is achieving full passive extension — losing extension early is one of the few mistakes that causes lasting trouble, so the physiotherapist will push hard on prone-hangs and heel-prop drills from day three or four.
Quadriceps shutdown — the inability to fire the quad through a straight-leg raise — is the other dominant story of week one. Most people get the SLR back by day five to ten, and it is a precondition for almost everything that follows.
documented at this week
This week
Weight bearing starts immediately
The MOON protocol starts full weight bearing as tolerated right away, usually with crutches for support — immediate loading was shown to reduce later kneecap pain, not endanger the graft.
The pattern
The first week falls fast
In a day-case series tracking worst daily pain, scores fell from 4.1/10 on day one to 2.5 by day seven. The steep early decline is the documented shape — most of the acute pain resolves within the first week.
The pattern
The graft you got barely changes the first two days
An RCT comparing the two common grafts measured pain every six hours. Bone-patellar-tendon-bone scored 5.2 then fell to 2.1 by 48 hours; hamstring scored 5.2 then fell to 1.6 — with no significant difference at any timepoint in that window.
Where it shows up
Loading the knee early is linked to less kneecap pain
The MOON guideline notes that in the one study of immediate full weight bearing, front-of-knee (patellofemoral) pain fell from 35% to 8%. The front of the knee is the spot most affected, and early loading is linked to less of it.
The bigger picture
Patellar-tendon vs hamstring graft and the chance of a second surgery
Across 45,998 ACL reconstructions in the Scandinavian registries, the risk of needing a revision was lower with patellar-tendon grafts than with hamstring grafts (hazard rate ratio 0.63). The same direction held across age, sex, and cartilage-injury subgroups. Which graft you have is decided in the operating room, so this is a difference between recovery paths rather than something a person changes after surgery.
Coming up
Needing a procedure to free up a stiff knee is uncommon
In an insurance-database review of 7,798 people who had ACL reconstruction between 2007 and 2017, 115 of them — about 1.5% — went on to need a manipulation under anesthesia within the first year to address stiffness. The other 98.5% did not.
milestones around now
- wk 0 ·Full weight-bearing as tolerated (Day 0 to 2 weeks, usually with crutches)
- wk 3 ·Off crutches / normal gait (2-6 weeks; criteria include quad control and full extension)
sources
What this page is built from
- MOON longitudinal prospective ACL reconstruction cohort prospective cohort · reliability 10/10
- MOON ACL reconstruction rehabilitation guidelines society guideline · reliability 9/10
- Immediate post-operative pain in ACL reconstruction RCT · reliability 7/10
Track your own week-by-week so a flare doesn't erase the months behind it.
Start a recovery logThis is a typical, evidence-anchored reading of acl recovery at week 1 — not medical advice, not a prediction for your body, and not a substitute for your surgeon or clinician.