An Important Finding About Immediate Weightbearing After ACL Reconstruction

This one flies in the face of aftercare trends for this operation, and negative findings almost always are informative

An Important Finding About Immediate Weightbearing After ACL Reconstruction

What’s the Claim?

A retrospective, comparative study raises red flags about early weightbearing after ACL reconstruction. Specifically, patients who were allowed immediate weightbearing had lower Lysholm and Cincinnati knee scores 3 years after ACL reconstruction. The data presentation in this study was sparse, but the difference in Lysholm scores was large — almost 20 points — favoring nonweightbearing. Tegner and IKDC score differences likewise favored nonweightbearing over immediate weightbearing.

How’s It Stack Up?

There is shockingly little high-quality evidence on the topic of weightbearing after ACL reconstruction — the only randomized trial we found is now over 25 years old, evaluated fewer than 50 patients, and concluded that there was no disadvantage to immediate weightbearing. That study, as was the case for many of its time, lacks many of the features we’d seek in an RCT today, the follow-up was at a mean of only 7 months after surgery, and the results are difficult to interpret using today’s standards. Despite all those issues, that was the only study cited in the most-recent review we could find on the topic of ACL recon aftercare, which suggested “early weightbearing appears beneficial and may decrease patellofemoral pain,” echoing an earlier set of guidelines based, again, on that single, ancient RCT. We’re dubious.

What’s Our Take?

The current study is not going to win a Nobel Prize for study design — it’s got real gaps — but studies that identify potential harms of commonly used approaches often contain the kind of honest reporting surgeons really need.

Curiously, it excluded patients who used postoperative braces, which many surgeons use. Still, we don’t see that as a reason to discount the findings; bracing and weightbearing interact, but their impacts also are likely to differ.

  • This topic cries out for a modern RCT using contemporary approaches to the procedure, as well as to bracing and other elements of aftercare.

The findings here would be enough to cause us to dial back the rehab from “full go” to restricted weightbearing, pending the findings of the next well-done RCT on the topic.

May it come soon.


Kaya S, Unal YC, Guven N, et al. The Impact of Early Weight-bearing on Results Following Anterior Cruciate Ligament Reconstruction. BMC Musculoskelet Disord. 2024;25:395.