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ACL Reconstruction – Retear and Rehabilitation Information

Medically reviewed by Dr. Sabrina Strickland, MD · Orthopedic Surgeon, Hospital for Special Surgery · Last reviewed: December 13, 2023

Quick Summary

Preventing an ACL retear after reconstruction depends on graft choice, surgical technique, and disciplined rehabilitation. The highest-risk window is the first 12 months as the graft heals and matures. Structured progressive rehab — with strength, neuromuscular control, and objective return-to-sport testing — significantly lowers retear risk, especially in young pivoting-sport athletes. Adding lateral extra-articular tenodesis (LET) is also considered in higher-risk patients.

  • February 16, 2023
ACL Reconstruction - Retear and Rehabilitation

Watch this short video to learn about the techniques that will hopefully prevent a retear of the ACL after surgery and the rehabilitation process after undergoing an ACL reconstruction.

When you look at the studies of ACL reconstruction, most show that there’s about a 12% chance of a retear. Those odds are pretty high, so we’re constantly looking at new ways to reduce that retear rate. We’re also looking at ways to make that surgery less invasive.    

 

To learn more, watch the video: ACL Reconstruction – Retear and Rehabilitation

Frequently Asked Questions

What is the retear rate after ACL reconstruction?

Reported retear rates vary from roughly 5% in the general population to 15–20% in young pivoting-sport athletes. Risk is highest in the first 12 months, especially when patients return to sport before achieving objective strength and movement criteria. Graft choice, surgical technique, and rehabilitation quality all influence the rate.

What rehabilitation milestones matter most for preventing retear?

I focus on restoring full knee extension early, building quadriceps strength symmetry to within ~90% of the uninjured side, retraining hop and landing mechanics, and confirming psychological readiness before sport return. Calendar timing alone is not enough — patients who pass objective criteria have substantially lower retear rates than those cleared by months alone.

Does wearing a brace protect the ACL graft after surgery?

For most ACL reconstructions, functional bracing is optional after the initial protective phase and does not meaningfully change retear rates. I individualize bracing for revision cases, hyperlaxity, or athletes returning to high-risk sports. The most protective interventions remain strength work, neuromuscular training, and respecting return-to-sport timelines.

Related Reading

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Medical Disclaimer. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified physician regarding any questions about your orthopedic health. Individual results may vary based on diagnosis, anatomy, and overall health.
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