After ACL surgery, prioritize total calories and protein above all else. Aim for 2.0–2.5 g of protein per kg of body weight daily in the first six weeks, spread across four to five meals. Correct low vitamin D, add 2–3 g of omega-3s, and keep an eye on calories during rehab.
Lack of full knee extension after ACL surgery occurs due to post-op swelling/pain that inhibits the quadriceps, soft tissue guarding and scar tissue formation. This could lead to a structural block called a cyclops lesion, or a poorly positioned surgical graft. The window to address it is the first 4 weeks post-op.
The five milestones to hit in the early stages of rehab after ACL reconstruction are: (1) full passive knee extension matching the non-surgical leg, (2) controlled swelling and joint effusion, (3) voluntary quadriceps activation without quad lag, (4) normalized gait without crutches, and (5) knee flexion progressing to 90–110 degrees. Missing these foundations delays every subsequent phase of ACL rehab.
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