Tears of the Anterior Cruciate Ligament (ACL) are common in athletes who participate in sports that include cutting, jumping and physical contact. The ligament acts as one of the main stabilizing structures of the knee, as it limits anterior translation and excessive rotation of the tibia. While typically a sturdy ligament, it can be vulnerable to injury an individual is struck in the leg with their foot planted in the ground or if trying to land or change directions rapidly with poor feet positioning and body mechanics. As talked about in a previous article, there varying degrees to a strain of a ligament, ranging from mild to severe. A severe, grade 3, strain of the ligament indicates a complete tear of the ligament. When this happens, there will be significant instability present and limit one’s ability to effectively and efficiently run, cut, jump and change direction. A complete tear of the ACL will require surgical intervention for optimal return to play status.
ACL Reconstructive Surgery
This is a common surgery that is done routinely by orthopedic surgeons. In order to regain stability in the knee, you must reconstruct and essentially create a new ACL ligament. This is done one of two ways, through the use of either:
Allograft-A transplanted tissue, typically from a cadaver
Autograft-A transplanted tissue from another area of your own body. Typically, a portion of your own patella tendon or hamstring tendons is utilized.
Research on the various surgical techniques as to which one is the best can be controversial and mixed at times. Great results have been seen with both allograft and autograft techniques and typically comes down the surgeon’s preference or training background, patient preference, patient history of previous ACL surgeries/remaining available tissue and other complicating factors which vary from person to person such as infection risk.
Barring any unforeseen circumstances, you can expect to go home the day of your surgery. You will most likely be placed in a knee immobilizer brace and will utilize crutches to aid with mobility. Most doctors recommend to weight bear through the limb as tolerated. However, if you had meniscus repair (repairing damaged cartilage in the knee) there will likely be a period of non-weight bearing through the lower extremity post-op which will be determined by your surgeon. Following surgery you will need physical therapy to return to your prior level of function and this will typically start with an initial evaluation roughly one week following your surgery. 10-14 days after your surgery you can expect to go back for your first follow-up visit with your surgeon to monitor your progress, answer any questions and remove your sutures or staples from the incision. Physical therapy will typically be performed 2-3x/week at an outpatient clinic. Your sessions will focus on limiting post-op pain and swelling, regaining full range of motion and strength and eventually returning to running and other sport specific activities.
How Long Until I Am Back To Normal and Playing Again?
Post-op timelines are variable depending on post-op precautions/restrictions put in place by your surgeon and how quickly your post-op pain and swelling resolves. Without post-op complications, most individuals are cleared to return to running 12-16 weeks post-op. At 6 months, most individuals are cleared to return to practice and training for their desired sport and will be fitted for a brace prior to this. It typically takes a full 12 months to not only be cleared to play in competitive games, but to be at your full speed, strength and previous ability. Return to play decisions are multi-factorial and depend heavily on a variety of factors such as your ability demonstrate appropriate functional movement patterns, ability to run/jump/change direction without compensatory strategies and the sport in which you are returning too. Greater caution may be utilized for those returning to heavier contact sports such as football, ice hockey or lacrosse. There several return to play tests that are utilized to determine your status such as the ACL Hop and Stop Test, Y-Balance Test, Selective Functional Movement Assessment and the Drop Jump Test.
ACL injuries and surgical reconstruction are commonplace today for individuals of all age and skill levels. It is crucial that you find an orthopedic surgeon who regularly performs knee surgeries and a rehab facility that specializes in sports medicine. At Rehab 2 Perform, every therapist you encounter holds a Doctorate in Physical Therapy, is a Certified Strength and Conditioning Specialist and is well versed in the sports medicine and performance training field. In addition, we operate out of a facility with state of the art rehabilitation and training equipment as well as access to two turf fields to meet the needs and demands of any sport.