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The essential handover pack
- Operation date and operative note
- Graft type and harvest site
- Fixation used
- Meniscus repair, cartilage work or other associated procedure
- Weight-bearing and range-of-motion instructions
- Brace instructions, if a brace is required
- Wound and medication plan
- Early rehabilitation completed in Kannur
- Follow-up and imaging plan
- Routine contact route and local emergency plan
Choose the physiotherapist before surgery
Ask whether the therapist regularly manages ACL reconstruction and whether they can follow procedure-specific restrictions. Later rehabilitation should have access to progressive strength work, running preparation and supervised change-of-direction tasks.
Reserve the first post-return appointment before travel. If the therapist cannot see the patient soon after landing, decide who will review the wound, gait and early movement in the meantime.
Early priorities
The first phase is not a race for impressive exercises. The usual priorities are a settled wound, control of swelling, full knee extension, progressive quadriceps activation and a safe gait. Flexion improves as symptoms and any procedure-specific restrictions allow.
A repaired meniscus or cartilage procedure may change weight bearing and bending. The operation-specific instruction always overrides a generic ACL schedule. [1]
How progression should be decided
Calendar time matters because graft biology and tissue healing take time. It is not the only measure. The physiotherapist also checks pain, swelling, range, strength, control and the quality of each task.
Later progression may include running preparation, landing, hopping, deceleration and change of direction. Each new load should produce an acceptable response during and after training. [1]
Separate healing restrictions from performance goals
A meniscus repair or cartilage procedure may create a temporary limit because tissue needs protection. Strength criteria answer a different question: whether the athlete has enough capacity for the next task. Both must be satisfied.
This prevents a patient from running simply because enough weeks have passed, or remaining unnecessarily inactive after the restriction has ended but strength is progressing well.
A useful therapist update is specific
“Doing well” is hard to interpret across countries. A better update records swelling, extension and flexion, current walking aid, quadriceps control, exercise loads and the knee's response the next day. Later reports can add strength values, hop measures and video of selected tasks.
Use the same testing method over time where possible. Changing equipment or instructions can create an apparent improvement that is not real.
Copyable therapist progress update
- Review date and procedure: operation date, graft, associated repair and current restrictions.
- Symptoms: pain, swelling, any giving way or locking, and response the next day.
- Movement: extension deficit or hyperextension and flexion, in degrees, with the measurement method.
- Walking: aid, permitted weight bearing, gait and quadriceps control.
- Strength and tasks: exercise loads or test values, units, equipment and test method; use consistent methods for comparison.
- Plan: the next goal, proposed progression and the decision needing surgical input.
Blank fields mean not recorded or not tested, rather than a normal result. The printable handover sheet can travel between the therapist, local clinician and surgical team.
What works well by video?
A video review can discuss symptoms, inspect selected movements, review a physiotherapy report and refine the plan. A wound photograph may be shared through the approved clinical channel when requested.
Video cannot reliably assess warmth, calf tenderness, ligament stability or every cause of swelling and pain. Strength and hop testing require consistent local equipment and supervision. Urgent concerns need local examination.
Who does what in shared care?
- Operating team: explains the procedure, restrictions, expected reviews and surgical concerns.
- Home clinician: provides examination, wound or medical assessment, tests and urgent referral.
- Physiotherapist: measures progress, adjusts rehabilitation and reports meaningful changes.
- Patient: follows the agreed plan, records symptoms and raises setbacks early.
The handover should make these roles clear so concerns reach someone who can examine and treat them locally.
Return-to-sport testing
Testing may include quadriceps and hamstring strength, hop performance, movement quality and sport-specific tasks. Psychological readiness and confidence during graded exposure also matter. Passing one test does not create automatic clearance.
The aim is not simply symmetry with the other leg, because both legs may have lost capacity during recovery. For unrestricted pivoting or contact sport, planning commonly needs nine months or longer; guidance advises return should rarely be earlier than nine months. Testing, confidence and graded sport exposure still determine whether the athlete is ready. [1],[4]
Keep a simple rehabilitation record
Record the main exercises, loads, pain and swelling response, walking or running volume and important test results. A short consistent log helps the team see whether the knee tolerates progression. It is more useful than daily photographs with no measurements.
When a setback occurs, note what changed in training and how quickly symptoms settled. Persistent swelling, loss of extension or a new instability episode deserves discussion before the next progression.
How the broad phases connect
- Settle and restore: wound, swelling, extension, quadriceps and gait.
- Build capacity: progressive lower-limb strength, control and cardiovascular work.
- Prepare to run: tolerate appropriate single-leg loads and repeated tasks.
- Rebuild sport: landing, acceleration, deceleration, turning and reactive tasks.
- Return gradually: individual training, team practice and competition exposure.
The labels are useful for communication, not fixed dates. Meniscus or cartilage restrictions may alter the early phases. [1]
A practical communication rhythm
Follow-up is included as appropriate to the case. Before departure, the plan should explain the next local physiotherapy session and how progress will be reviewed. Further decisions, such as increasing weight bearing, running or sport-specific training, depend on the procedure and recovery.
Send concise updates in advance of a remote review. Include current range, swelling, walking, strength work, restrictions and the specific decision being considered. This leaves the consultation for interpretation instead of reconstructing several weeks of history.
Equipment should match the phase
Early care may need only a walking aid and simple exercise space. Later phases require enough resistance to rebuild the thigh and hip. Running and sport preparation need a safe surface and supervision appropriate to the task.
Buying braces, electrical devices or home machines is not a substitute for a progressive programme. Use equipment because it solves a measured problem, not because it appears on an ACL checklist.
Review the ACL flight guide when planning departure and the athlete guide for graft and return-to-sport decisions.
Questions to settle with the home therapist
- When is the first appointment after landing?
- Can the therapist measure strength consistently?
- Who checks the wound and medicines?
- How will swelling and range be reported?
- What facilities are available for running and sport testing?
- How are urgent concerns escalated locally?
- How will reports and imaging reach the surgical team?
