After ACL reconstruction surgery, one of the last things that patients may think about is the leg that they didn’t have surgery on. And rightfully so. Of course, the primary focus should be on following the post-operative protocol and precautions for the surgical limb. However, recent research has shown that deficits can occur in both the surgical and non-surgical limb after ACL reconstruction.

Once patients begin physical therapy after surgery they sometimes ask, “Should I do these exercises on both sides?” The short answer is yes. During in-clinic therapy sessions, special attention will be paid to the surgical leg. Again, for good reason. But, at home, it would be wise do your exercises bilaterally (on both sides) and to continue to strengthen the surgical and non-surgical leg even after “graduating” from PT.

A study by Pamukoff and colleagues in 2018 looked at several variables related to quadriceps function (the function of the muscle on the front of your thigh) and running mechanics after ACL reconstruction surgery. They compared surgical limbs and non-surgical limbs of post-op patients as well as “healthy” limbs of individuals in a control group who had not had ACL surgery.

Not surprisingly, they found differences in quad function and running mechanics when comparing the surgical limbs of post-op patients and the healthy controls. But the authors also found that biomechanical factors (i.e. factors relating to how our bodies move) were affected on both sides – the surgical and non-surgical limbs – after a patient had undergone ACL reconstruction surgery.

Here’s a few thoughts on why this might be: impairments in balance or postural control on one or both sides, compensations on the non-surgical side resulting from immobilization or weakness of the surgical side, weakness or muscle atrophy on both sides due to limited activity during the early stages of recovery.

Whatever the reason (or reasons) might be, the findings in this study suggest that it is important to assess and treat both the surgical and non-surgical limbs after ACL reconstruction surgery. Talk with your PT about how to best structure your plan of care to make sure that on the road to recovery, your other leg doesn’t get left behind.