When Can I Drive After ACL Surgery?

The short answer

Dr. Raynor clears most patients to drive about 6 weeks after ACL reconstruction on the right knee. After surgery on the left knee, in a car with an automatic transmission, many patients are ready in about 2 to 3 weeks, even while still in the brace. That fits the published studies, where braking speed returned to normal about 4 to 6 weeks after right-knee surgery and 2 to 3 weeks after left-knee surgery (Salem et al., 2021). With a manual transmission, either knee waits until about 6 weeks.

The calendar is only part of the answer. You are ready to drive when you are walking without crutches, off prescription pain medicine, and able to brake hard without hesitating.

Why the right knee takes longer after ACL surgery

In a car with an automatic transmission, the right leg does all of the braking. After ACL surgery the thigh muscles are weak and the knee is sore and stiff, so moving the foot from the gas pedal to the brake is slower than normal.

In one study, patients two weeks out from right ACL surgery took about 1.5 seconds to press the brake all the way down, compared with about 0.6 seconds for healthy drivers (Nguyen et al., 2000). At 60 miles per hour, that extra 0.9 seconds covers about 80 feet of road before the brake is fully on. By 6 weeks, the right-knee patients were no longer measurably slower than the healthy drivers. Patients who had the left knee done were braking normally by 2 weeks, the first time they were tested.

Are you ready to drive after ACL reconstruction? A checklist

You are ready to get behind the wheel when every one of these is true:

  • You are off prescription pain medicine. Drivers taking prescription opioids have about 2.3 times the odds of being in a crash (Chihuri and Li, 2017). In Dr. Raynor's practice, over-the-counter ibuprofen or Tylenol does not count against you.

  • The nerve block has worn off. In Dr. Raynor's practice, it usually wears off within 1 to 3 days.

  • You are walking without crutches.

  • If your right knee was operated on, the brace is off. No one should drive with a brace on the leg that works the pedals. After left knee surgery, Dr. Raynor allows driving an automatic while still in the brace, as long as everything else on this list is true.

  • You can get in and out of the car and sit with the knee bent without pain.

  • You have practiced first. You can stomp on the brake hard and fast without pain or hesitation. Practice a few hard stops in an empty parking lot before you drive in traffic.

Many patients drive before they are ready. In a study of 182 patients, people went back to driving a median of 11 days after ACL surgery (Obermeier et al., 2018), well before braking speed recovers after right-knee surgery in the simulator studies (Salem et al., 2021).

What can change the driving timeline after ACL surgery

  • A meniscus repair. In Dr. Raynor's practice, if a torn meniscus was repaired at the same time, you may be on crutches or in a brace locked straight for up to about 6 weeks. Driving waits until that phase is over.

  • A manual transmission. The left leg works the clutch, so a left knee matters as much as a right one. In a manual-transmission simulator, ACL patients tested 4 to 6 weeks after surgery did not score significantly worse than healthy drivers (Valentí et al., 2018). Even so, Dr. Raynor does not want patients pushing a clutch pedal until about 6 weeks after surgery, whichever knee was operated on.

  • Graft choice. In a small study of right-knee patients, those who received a donor tendon braked normally by 3 weeks, while those whose graft came from their own patellar tendon or hamstring were not back to normal until the 6-week test (Wasserman et al., 2017). With only 9 patients per graft, a soft-tissue donor graft different from the one Dr. Raynor uses, and no quad tendon group, that is a hint, not a rule.

  • Your own recovery. Strength, swelling and comfort come back at different speeds for different people, so the checklist above matters more than the date.

What the research shows about driving after ACL reconstruction

A 2021 systematic review pulled together the available studies on driving after ACL reconstruction: 5 studies and 281 patients. Braking speed returned to normal about 4 to 6 weeks after right-knee surgery and about 2 to 3 weeks after left-knee surgery (Salem et al., 2021).

  • Right knee: braking matched healthy drivers at 4 to 6 weeks (Gotlin et al., 2000).

  • Right vs. left knee: 6 weeks to normal braking for the right knee, 2 weeks for the left (Nguyen et al., 2000).

  • Three graft types, right knee: 3 weeks with a donor tendon; by the 6-week test with the patient's own patellar tendon or hamstring (Wasserman et al., 2017).

  • Manual transmission, either knee: driving skills and braking were not significantly different from healthy drivers when tested at 4 to 6 weeks (Valentí et al., 2018).

  • What patients actually do: they stopped opioid pain medicine a median of 9 days after surgery and were back behind the wheel at a median of 11 days (Obermeier et al., 2018).

These studies are small and mostly used driving simulators, so they describe a typical range, not a guarantee. The review's authors also stress that patients should be off opioid pain medicine before they drive.

The bottom line

Plan on about 6 weeks for a right knee, about 6 weeks for either knee with a manual transmission, and often 2 to 3 weeks for a left knee in an automatic, then let the checklist make the final call. These are general guidelines, and your own timeline depends on your surgery and your recovery. Dr. Raynor and his team will let you know when you are cleared to drive.

For the rest of the recovery, see the ACL Reconstruction FAQs, the ACL recovery roadmap (enter your surgery date to see where you are and what comes next), and ACL tears.

References

  1. Salem HS, Park DH, Friedman JL, Jones SD, Bravman JT, McCarty EC, Frank RM. Return to driving after anterior cruciate ligament reconstruction: a systematic review. Orthop J Sports Med. 2021;9(1):2325967120968556. doi:10.1177/2325967120968556

  2. Nguyen T, Hau R, Bartlett J. Driving reaction time before and after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2000;8(4):226-230. doi:10.1007/s001670000115

  3. Gotlin RS, Sherman AL, Sierra N, Kelly MA, Pappas Z, Scott WN. Measurement of brake response time after right anterior cruciate ligament reconstruction. Arch Phys Med Rehabil. 2000;81(2):201-204. doi:10.1016/s0003-9993(00)90141-2

  4. Wasserman BR, Singh BC, Kaplan DJ, Weinberg M, Meislin R, Jazrawi LM, Strauss EJ. Braking reaction time after right-knee anterior cruciate ligament reconstruction: a comparison of 3 grafts. Arthroscopy. 2017;33(1):173-180. doi:10.1016/j.arthro.2016.05.043

  5. Valentí A, Payo-Ollero J, Pérez-Mozas M, Lamo-Espinosa JM, Valentí JR. Evaluation of driving skills after anterior cruciate ligament reconstruction with hamstring autograft. Knee. 2018;25(5):790-798. doi:10.1016/j.knee.2018.07.015

  6. Obermeier MC, Sikka RS, Tompkins M, Nelson BJ, Hamilton A, Reams M, Chmielewski TL. Examination of early functional recovery after ACL reconstruction: functional milestone achievement and self-reported function. Sports Health. 2018;10(4):345-354. doi:10.1177/1941738118779762

  7. Chihuri S, Li G. Use of prescription opioids and motor vehicle crashes: a meta analysis. Accid Anal Prev. 2017;109:123-131. doi:10.1016/j.aap.2017.10.004

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