The importance of the ACL (anterior cruciate ligament) to knee stability can not be overstated. Next in line for importance is proper rehabilitation after an ACL injury and surgery.
Let’s start with the basics.
The ACL is responsible for keeping your knee from sliding or twisting behind your hamstring. If the ACL is torn it pops and your knee begins to wobble. (See the seven simple tests to determine if you’ve torn your ACL.) The pain is excruciating.
Unfortunately, even though ACL injuries are common, women ages 14 to 30 are five times more than likely to suffer from an ACL injury. The reason why is not understood fully. It could be anatomy or estrogen levels or proper strength training.
An exact rehabilitation and recovery program from an ACL injury, especially if you’ve opted for reconstructive surgery, will vary from doctor to doctor and therapist to therapist
You can expect to be back at the sport in about six months. It’s best not to expect anytime sooner than that, unless you hit your benchmarks early.
Your first benchmark is to take care of the pain and swelling. Next it’s vitally important to protect the knee during the time it is healing from the surgery. Slowly a return in motion is something we also look for, then looking for a return in strength.
So it’s resolving the pain and swelling, protecting the knee to heal properly, return in motion and strength are what make up a good rehabilitation program. These are the benchmarks we look for in sports medicine.
Most of these steps we have control over. What we don’t have control over is the biology of the individual: will he heal fast or slow? Will the graft become a living part of the body again is not so much a concern as when that will happen. It differs from individual to individual.
What’s happening is the body is trying to re-establish blood flow to the graft that has been taken from another part of your body.
Six months is the benchmark where we can expect most athletes to be completely recovered and ready to play again. Some doctors will be aggressive with the rehabilitation and try and get the athlete back on the field in two or three months.
So much of that depends upon the athletes desire and how his or her body responds to the graft and the recovery program. The knee has to be strong enough and the full range of motion must have returned, as well as a dramatic reduction and even elimination of pain and swelling. If these benchmarks aren’t hit then the doctor and athlete need to be patient because the threat of re-injury is very real.
Of course six weeks after the surgery your knee may be healthy and strong enough, although not optimally at the strength target, that the risk of re-injury is not a worry and you could return to playing at that point.
I don’t fully recommend, however, doing this, but at the eight week the knee may be healed enough that I wouldn’t be worried about re-injury as much. Still, the longer the knee can be given to heal the stronger it will be and the less likely you will re-injure it.
In fact, your new knee ligament continues to heal for up to a year, meaning it won’t be as strong at nine months as it will be at twelve months. The longer you wait, the better.
But you can make a personal decision, along with the advice of your therapist, doctor and coach, of returning to the game in two months. You may not be up to your original performance standards pre-ACL surgery at this point, but in good enough shape to play.
Dr. Rick Lehman is a distinguished orthopedic surgeon in St. Louis, Missouri and an articular cartilage reconstruction pioneer He owns U. S. Sports Medicine in Kirkwood, MO, and LehmanHealth. Learn more about Dr. Rick.