ACL Surgery Rehabilitation

In the world of sports and physical activity, injuries are unfortunately common. One of the most dreaded injuries, particularly among athletes, is a tear in the anterior cruciate ligament (ACL). This ligament, located in the knee, plays a crucial role in providing stability to the joint during movements like running, jumping, and pivoting. When the ACL is torn, it can severely impair a person’s ability to engage in physical activities and may require surgical intervention followed by rehabilitation to regain strength and function.

 

What is the ACL and Why is it Important?

Before diving into surgery and rehabilitation, it’s essential to understand the anatomy of the knee and the role of the ACL. The knee joint is a complex structure consisting of bones, ligaments, tendons, and cartilage. The ACL is one of the major ligaments in the knee, situated in the center of the joint. Its primary function is to prevent the shin bone (tibia) from sliding too far forward relative to the thigh bone (femur). This stability is crucial for activities that involve quick changes in direction or sudden stops, common in sports like soccer, basketball, and skiing.

Understanding ACL Tears: An ACL tear is a common knee injury, often occurring during sports activities that involve sudden stops or changes in direction. It can happen due to a variety of reasons, including awkward landings, sudden twisting motions, or direct impact to the knee. When the ACL tears, it typically results in a popping sensation accompanied by immediate pain and swelling in the knee. Some individuals may also experience instability or a feeling of the knee giving way.

The Role of Surgery in ACL Tears: While not all ACL tears require surgery, it is often recommended for individuals who wish to return to activities that involve cutting, pivoting, or jumping. The goal of ACL surgery is to reconstruct the torn ligament using either tissue from the patient’s own body (autograft) or from a donor (allograft). The choice of graft depends on various factors, including the patient’s age, activity level, and surgeon preference.

The Surgical Procedure: ACL reconstruction surgery is typically performed arthroscopically, a minimally invasive technique that allows the surgeon to visualize and repair the knee joint through small incisions. During the procedure, the torn ACL is removed, and the graft tissue is inserted in its place. The graft is secured using screws or other fixation devices to hold it in position while it heals and integrates with the surrounding tissue.

Anterior cruciate ligament (ACL) reconstruction surgery is done to recreate the torn ACL ligament using grafts. The is performed using an arthroscope that utilizes key-hole incisions. The rehabilitation after ACL surgery forms an important part of recovery. Non-compliance with rehabilitation protocol may be linked with poor outcomes of the surgery and continued pain and stiffness.

Intraoperative image showing ACL reconstruction.

Intraoperative image showing ACL reconstruction.

Phase (I) Initial postoperative period (0-2 weeks)

The rehabilitation protocol in the initial four weeks of the surgery is aimed towards graft protection, reducing pain and swelling, improving flexibility and muscle strength. A knee brace is usually worn in the first 4-6 weeks while standing and walking.

Walking is permitted with the use of crutches in the first few weeks with weight-bearing as tolerated by the patient. The brace may be taken off while bathing and during exercises. The brace may be locked at first and as the patients slowly gained confidence with therapy and standing, the brace may be unlocked and finally taken off.

While navigating stairs, patients are encouraged to place their normal (non-operated) knee first on the step and the operated knee first along with the crutch while coming down.

The patient is advised to maximize the effort to try to straighten the leg completely (or equal to the other leg). The patients are encouraged to try to bend their knee to 90 degrees in the first 10 days.

Stretching of the knee to improve extension may be done using prone hang, prone hang involves lying with your abdomen touching the bed with gradually shifting the legs below the one of the bed.

Instruments used in knee arthroscopic surgery.

Instruments used in knee arthroscopic surgery.

Strengthening exercises such as quadriceps and hamstring exercises are encouraged. The quadriceps muscles are present in front of the thigh and help in keeping the leg straight. The patients are advised to try to press the back of their knees to the bed while trying to contract the thigh muscles. The exercise is repeated in sets with incremental repetitions. Straight leg raise exercise may be done to increase the strength of the quadriceps.

Ankle pumps involve trying to push the ankles down and holding in the position for a few seconds. Multiple repetitions are done and ankle pumps not only help in building the strength of calf muscles but also help in preventing the incidence of deep vein thrombosis. The above exercises may be performed with the assistance of the therapist as well.

The patients are also advised to move their kneecap (patella) using their hands. Mobilization of the patella prevents the formation of adhesions that may cause stiffness. Swelling after ACL reconstruction is normal and may be managed by leg elevation above the heart level and regular icing. Compression with an ace bandage is also used to reduce the incidence of swelling.

Phase (II) 2-5 weeks post-op

Towards the end of 5 weeks, depending upon the progress, the patient may usually walk without the crutches and a knee brace. The stretching and exercise regime is further progressed with advanced exercises. The patients may use stationary bikes for range of motion exercises. Hamstring and quadriceps exercises may be done in the form of hamstring curls and mini squats. Balancing may be improved with the practice of a single-leg stance.

Phase (III) 5-8 weeks post-op

Range of motion, stretching, and strengthening exercises are continued. As the level of exercise increases, the patients are advised to avoid exercises that may precipitate pain and swelling. Exercises may be performed with equipment under the supervision of a therapist. At the end of phase 3, patients are able to walk normally without assistance and demonstrate a range of motion equal to the other knee.

Phase (IV) 8-12 weeks post-op

The patients are encouraged to safely transit to submaximal sports and athletic activities. The level of strength training and stretching is further advanced to build muscle and improve balance. All the activities are done in a safe manner when there is no associated pain.

Phase (V) 5 months post-op

Running may be resumed along with other cardiovascular exercises. The strength training and stretching program is continued. The patient’s progression is actively monitored by the physical therapist and the surgeon.

Phase (VI) 6 months post-op

The patients are allowed to safely return to full sports or athletic activities.

 

Common Challenges and Complications

While ACL surgery and rehabilitation have high success rates, there are potential challenges and complications that may arise during the recovery process. These can include:

  1. Persistent pain or swelling
  2. Limited range of motion
  3. Muscle weakness or imbalance
  4. Graft failure or re-tear
  5. Psychological factors such as fear of re-injury

It’s essential for individuals undergoing ACL surgery to communicate openly with their healthcare team and adhere to their rehabilitation program to minimize the risk of complications and optimize outcomes.

 

Conclusion

In summary, ACL surgery and rehabilitation are integral components of the treatment plan for individuals with ACL tears, particularly those who wish to return to sports or physically demanding activities. By understanding the anatomy of the knee, the mechanism of injury, and the goals of treatment, individuals can make informed decisions about their care and actively participate in their recovery journey. With proper surgical technique, diligent rehabilitation, and patience, many individuals are able to regain strength, function, and confidence in their knees, allowing them to return to the activities they love.

Do you have more questions?Ā 

How soon after ACL surgery can I start walking without crutches?

Walking without crutches typically begins within the first few days to weeks after ACL surgery, depending on the individual’s progress and the surgeon’s recommendation.

Will I need to wear a knee brace while sleeping after ACL surgery?

It is not typically necessary to wear a knee brace while sleeping after ACL surgery, as long as the knee is adequately supported and protected during the early stages of recovery.

Can I take baths or swim after ACL surgery?

It is generally recommended to avoid soaking the incision site in water, such as baths or swimming, until the wound has fully healed and the stitches or surgical staples have been removed, usually within 7 to 14 days after surgery.

How soon after ACL surgery can I begin driving?

You can typically resume driving once you are no longer taking prescription pain medications and have regained sufficient strength and control in your operated leg, which may occur within 2-4 weeks after surgery. However, it’s important to follow your surgeon’s guidance and ensure that you can safely operate a vehicle.

Will I need to wear a knee brace during physical activities after ACL surgery?

The use of a knee brace during physical activities after ACL surgery depends on various factors, including the surgeon’s recommendation, the type of graft used, and the individual’s specific needs. Some patients may benefit from wearing a brace for added support and protection during sports or high-impact activities.

Can I return to playing sports after ACL surgery?

Returning to sports after ACL surgery depends on several factors, including the individual’s progress in rehabilitation, the specific demands of the sport, and the risk of re-injury. It’s essential to consult with your surgeon and physical therapist before returning to sports activities to ensure that your knee is strong and stable enough to withstand the demands of play.

How long will I need to use crutches after ACL surgery?

The duration of crutch use after ACL surgery varies depending on the individual’s progress and the specific surgical technique used. Some patients may need crutches for a few days to a few weeks to offload weight from the healing knee.

What activities should I avoid after ACL surgery?

During the early stages of rehabilitation after ACL surgery, it’s important to avoid high-impact activities, heavy lifting, and exercises that put excessive strain on the knee joint. Your physical therapist will provide guidance on which activities to avoid and which ones are safe and appropriate for your stage of recovery.

Can I return to work after ACL surgery?

The timing of returning to work after ACL surgery depends on various factors, including the type of job, the extent of the surgery, and the individual’s progress in rehabilitation. Desk jobs may be resumed within a week or two, while jobs that involve physical labor or prolonged standing may require more time off.

How long does it take to fully recover from ACL surgery?

The timeline for full recovery after ACL surgery varies depending on factors such as the extent of the injury, the surgical technique used, and the individual’s commitment to rehabilitation. In general, it may take 6 to 12 months to regain full function and return to sports or physically demanding activities.

Can ACL surgery be done using a minimally invasive technique?

Yes, ACL surgery is typically performed using arthroscopic techniques, which involve making small incisions and using specialized instruments to repair the knee joint. This minimally invasive approach allows for quicker recovery and less postoperative pain compared to traditional open surgery.

How soon after ACL surgery can I return to playing sports?

The timing of returning to sports after ACL surgery depends on several factors, including the individual’s progress in rehabilitation, the type of sport, and the risk of re-injury. In general, most patients can expect to return to sports activities within 6 to 9 months after surgery, but this timeline may vary depending on individual circumstances.

Will I need to undergo physical therapy after ACL surgery?

Yes, physical therapy is an essential component of rehabilitation after ACL surgery. A structured program of exercises, stretches, and functional activities is designed to restore strength, mobility, and function to the knee and help prevent future injuries.

How soon after ACL surgery can I start jogging?

Jogging typically begins within 3 to 6 months after ACL surgery, depending on the individual’s progress in rehabilitation and the surgeon’s recommendation. It’s important to start gradually and listen to your body to avoid overexertion and re-injury.

Can ACL surgery be done as an outpatient procedure?

Yes, ACL surgery is often performed as an outpatient procedure, meaning the patient can go home the same day as the surgery. However, this may vary depending on individual circumstances and the surgeon’s preference.

How long will I need to wear a knee immobilizer after ACL surgery?

The duration of wearing a knee immobilizer or brace after ACL surgery varies depending on the surgeon’s recommendation and the individual’s specific needs. It may be worn for a few days to a few weeks to provide support and protection to the healing knee.

Will I need to take pain medication after ACL surgery?

Pain medication may be prescribed after ACL surgery to manage postoperative discomfort. Over-the-counter or prescription pain relievers, as well as anti-inflammatory medications, may be used as needed to control pain and swelling.

The duration of physical therapy after ACL surgery varies depending on the individual’s progress and the specific goals of rehabilitation. Most patients continue physical therapy for several months to ensure optimal recovery and functional outcomes.

Returning to contact sports after ACL surgery depends on several factors, including the individual’s progress in rehabilitation, the specific demands of the sport, and the risk of re-injury. It’s essential to consult with your surgeon and physical therapist before returning to contact activities.

How long will I need to attend physical therapy sessions after ACL surgery?

The duration of physical therapy after ACL surgery varies depending on the individual’s progress and the specific goals of rehabilitation. Most patients continue physical therapy for several months to ensure optimal recovery and functional outcomes.

Will I need to undergo imaging tests after ACL surgery to monitor my progress?

Imaging tests such as X-rays or MRI scans may be ordered by your surgeon to assess the healing process and monitor the integrity of the reconstructed ACL. These tests are typically performed at follow-up appointments to ensure that the knee is healing properly and to guide further treatment as needed.

Can ACL surgery be done using a cadaver graft?

Yes, ACL surgery can be performed using a cadaver graft, also known as an allograft. This involves using tissue from a deceased donor to reconstruct the torn ACL. The decision to use a cadaver graft depends on various factors, including the patient’s age, activity level, and surgeon preference.

How soon after ACL surgery can I return to high-impact activities like jumping and running?

High-impact activities like jumping and running typically resume within 6 to 9 months after ACL surgery, once the knee has regained sufficient strength and stability through rehabilitation. It’s important to follow your surgeon and physical therapist’s guidance to prevent re-injury and ensure a safe return to these activities.

Suhirad-Khokhar-MD

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS (Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.

My profile page has all of my educational information, work experience, and all the pages on this site that I've contributed to.