Before surgery, after reconstruction, or managing a tear without an operation — Dr. Cisneros rebuilds the knee to measured criteria, not a calendar, one-on-one for the full hour every visit. Quad strength, hop testing, and a real return to running, lifting, and sport.
An ACL injury is one event with four very different rehab problems, depending on when you walk in. Each one is diagnosed and loaded differently.
Swelling, a knee that will not straighten, and the question of whether you need surgery at all. The answer comes from a structured rehab trial and stability testing, not from the MRI alone.
The weeks between injury and the operation. A quiet, straight, strong knee going in comes out weeks ahead. The most valuable stretch of ACL rehab, and the most often skipped.
Extension, swelling control, patellar mobility, and waking the quadriceps up. Losing full extension here is the mistake that follows people for a year.
Heavy, progressive quad and hamstring work, single-leg control, and the earned milestone of running. This phase decides how the knee holds up under sport.
Criteria-based testing — strength symmetry, hop tests, landing mechanics — and a structured re-entry to practice before games. Cutting this short is where re-tears come from.
Six or twelve months out and still not confident, still swelling, or told you are "done" with a knee that is not. A fresh assessment finds what was never rebuilt.
Every one of these starts with an assessment of what the knee can and cannot do today, then a loading program built to the surgeon’s protocol where there is one and to test criteria where there is not.
Surgery restores the structure. Rehab decides what you can do with it. Dr. Cisneros follows your surgeon’s protocol for the restrictions and builds the loading around measured criteria, not the calendar.
Full extension, a quiet knee under load, quad strength symmetry, and hop testing gate every progression — walking without a limp, running, cutting, and clearance. Each is tested before the next phase opens, so the program moves as fast as the knee allows and no faster.
The quad shuts down hardest after this surgery and predicts the outcome. Heavy, progressive strength work — leg press, split squats, step-downs, isometrics early — with strength compared side to side, not assumed. Dr. Cisneros’s Olympic weightlifting background shapes how squat and hinge mechanics are rebuilt.
Patellar and joint mobilization to restore extension and flexion, soft-tissue work around the graft site, and dry needling for the guarded quad, hamstring, or calf that will not let go. Support for the loading plan, never a substitute for it.
Sport-specific drills, landing and deceleration mechanics, and a structured re-entry to practice before competition. Athletes cleared here have passed a test, not a date. For CrossFit, lifting, soccer, and basketball the last phase is built around the demands of that sport.
Plan on 9–12 months from surgery to a safe return to cutting and contact sport, and 4–6 months to return to straight-line running. Those are ranges, not promises: the timeline is set by criteria — full knee extension, quad strength close to symmetrical, hop tests within 90% of the other leg, and clean landing mechanics — not by the calendar. Dr. Cisneros tests each milestone before progressing rather than moving on a date.
Running is a milestone you earn, usually somewhere between 3 and 5 months. The gate is a quiet knee (no swelling after loading), full extension, a single-leg squat you can control, and quadriceps strength at roughly 70% or more of the uninjured side. Starting to run before the quad is ready is the most common way an ACL rehab stalls at month six.
Some people do well without reconstruction — typically those with an isolated tear, no repeated giving-way, and a life that does not depend on cutting and pivoting. A structured 8–12 week rehab trial is the honest way to find out: if the knee is stable through hop testing and sport-specific drills, non-surgical management is reasonable. If it gives way, surgery is the safer path. Dr. Cisneros will tell you which group you are in rather than guess.
Prehab is the 2–6 weeks of physical therapy between injury and surgery. The goals are simple: get the swelling down, restore full extension, and rebuild quad activation before the operation. Patients who go into surgery with a quiet, straight, strong knee come out of it weeks ahead. It is one of the highest-value stretches of the whole process and the most often skipped.
Swelling control, full knee extension, patellar mobility, and getting the quadriceps to fire again — quad sets, straight-leg raises, heel slides, and walking normally without a limp as soon as your surgeon allows. Losing extension early is the mistake that follows people for a year. Sessions in this phase are hands-on and frequent, and the home program matters as much as the visits.
Yes, in the details. A patellar-tendon graft tends to produce more anterior knee pain and needs careful kneeling and quad-tendon loading; a hamstring graft needs hamstring strength protected early and rebuilt deliberately; a quad-tendon graft sits between the two. Dr. Cisneros follows your surgeon's protocol for the ranges and restrictions, then adapts the loading to the graft you have.
Because it is the single best predictor of how you will do. Quadriceps strength symmetry under 90% at return to sport is associated with higher re-injury rates, and the quad is the muscle that shuts down hardest after this surgery. Heavy, progressive strength work — not just balance drills — is the core of a good ACL program, and it has to be measured, not assumed.
It lowers it substantially when the program is finished properly. Second ACL injuries cluster in athletes who return before strength and hop symmetry are met, and in the first year back. A criteria-based return-to-sport test and a slow, structured re-entry to practice are the two things that most change that risk. Cutting the program short at month six is where the re-tears come from.
After surgery you already have one — your surgeon's post-operative order counts, and Dr. Cisneros works from that protocol. Before surgery, or for a non-surgical tear, Texas direct access lets you start physical therapy without a referral for 30 consecutive days; a referral is needed to continue past that, which Dr. Cisneros will flag well in advance.
It is a long course by design, so visits are spaced to make each one count: more frequent in the first weeks, then weekly or every other week as you take over the strength work at the gym with a written program. Sessions are $120 for a full hour one-on-one, $150 for the initial evaluation, with no insurance billing. Dr. Cisneros will give you a realistic visit plan at the evaluation rather than an open-ended schedule.
Solas Physical Therapy is a top-rated choice for ACL rehabilitation in El Paso, holding a 5.0-star rating across 36 Google reviews. Every session is a full hour one-on-one with Dr. Andrew Cisneros, PT, DPT, MS — no aides, no shared time — with a strength-and-conditioning background that shows in how the return-to-sport phase is built: measured quad symmetry, hop testing, and a real progression back to running, cutting, and lifting. Solas PT is cash-based, direct-access, at 300 N Resler Dr, Ste F in west El Paso.
Same-week appointments available. No referral needed. One-on-one with Dr. Cisneros every session.
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