If you’ve recently had ACL reconstruction surgery, your knee is now going through several phases of healing—and one of the most critical (but least talked about) is the revascularization phase.
At Vertex PT Specialists, we help patients across Columbia, Cayce, and Irmo, SC safely navigate this crucial stage so they can get back to sport, training, or everyday life without setbacks.
What Is the Revascularization Phase?
After ACL reconstruction, your surgeon typically uses a graft—often a patellar tendon, hamstring tendon, or quadriceps tendon—to replace the damaged ligament. That graft is initially avascular, meaning it doesn’t have its own blood supply.
Over the next several weeks, your body begins a process called revascularization, in which new blood vessels form within the graft. This helps deliver oxygen, nutrients, and immune cells to the healing tissue, and sets the foundation for long-term graft integration.
Timeline: When Does Revascularization Happen?
- Starts: Around week 4 post-op
- Peaks: Between weeks 6–12
- Clinical significance: This is the time when the graft is biologically weakest, even if you feel stronger
This is one of the most dangerous times to do too much too soon.
⚠️ Why You Shouldn’t Rush ACL Rehab During This Phase
Even if the swelling has gone down and your range of motion is improving, the graft is still structurally vulnerable. This is when a misstep—like trying to jog early, jump, or pivot—can lead to a re-tear or failed reconstruction.
Our Columbia-based ACL physical therapists often tell patients:
“This is when you feel good—but the graft isn’t ready yet.”
✅ What You Should Focus On Instead
During this phase of ACL rehab, your physical therapist will progress you through targeted exercises that promote healing without overstressing the graft. These may include:
- Active and assisted range of motion to maintain mobility
- Early quadriceps and hamstring activation, including isometrics and light band work
- Swelling and inflammation control to support tissue healing
- Progressive weight-bearing as tolerated, focusing on quality of movement
- Foundational glute, trunk, and hip stability exercises to prepare for loading phases
As your knee tolerates more, your therapist will begin layering in low-load strength work and neuromuscular control drills that build toward return-to-sport milestones. The goal during revascularization is steady, structured progression—not stagnation or aggressive timelines.
Clinical Insight from Vertex PT
At Vertex PT Specialists, we see a high volume of ACL reconstructions, especially among athletes, tactical professionals, and active adults in the Midlands region of South Carolina. Our experience has shown that:
- Skipping ahead during the revascularization phase increases the risk of graft failure
- Adherence to evidence-based protocols yields faster return-to-sport timelines and lower reinjury rates
Every rehab plan is individualized, based on graft type, sport demands, and tissue healing.
ACL Physical Therapy in Columbia, SC
If you’re looking for ACL rehabilitation near Columbia, SC, you’re in the right place.
At Vertex PT, we help patients through every stage of the ACL recovery process—including the often-overlooked revascularization phase. With clinic locations in Cayce, Irmo, and Downtown Columbia, we’re trusted by orthopedic surgeons, coaches, and athletes alike.
Ready to Start Rehab or Reassess Your Current Plan?
Whether you’re 4 days or 4 weeks post-op, we’ll build a program that meets you where you are.
Contact Us Today
Reference
Sawyer GA, Anderson BC, Christiansen BA. The Revascularization Phase of Tendon and Ligament Healing and its Relationship with Fibrosis. Curr Rheumatol Rep. 2021 Feb 10;23(3):16. doi: 10.1007/s11926-021-00972-y.