Navigating rehabilitation after ACL repair or reconstruction

When you’re in good shape, you move easily, usually without thinking about it too much. You go for a run, go to the shops and chase after your kids, taking your ease of movement for granted.

But then you twist your knee, probably in a fast-paced pivot. Maybe you were playing netball or football or perhaps you were traversing a ski slope. You may have heard an audible pop followed by intense pain.

And then your life changes.

Your days revolve around pain, tests, exercises and medical appointments as you begin to navigate life with an ACL injury. You have to rest far more than you’re used to doing. It’s not an easy road.

What is an ACL injury?

Your anterior cruciate ligament (ACL) is a ligament deep within the knee. Along with your ACL, your knee contains other ligaments, bones, cartilage and tendons. Specifically, it is more important pivoting and twisting sports, but injury to it can effect patients in a variety of ways (sometimes severely, and sometimes not at all!).

Your ACL can be injured during sports that involve sudden stops, pivoting and jumping. Your risk of an ACL injury is influenced by your gender, biomechanics and movement patterns.

ACL repair or ACL reconstruction?

ACL injuries can be complex. Operative and non-operative options should be considered. Surgery may be recommended for:

  • Young, active patients who will continue to place high demands on their knee
  • Multi-ligament knee injuries
  • ACL injuries with bucket-handle meniscus tears
  • Isolated ACL injuries with knee instability, pain and swelling that persists after rehabilitation.

Medicine and surgery are always evolving. The first open ACL repair surgery, which involved sewing the torn ACL back together, was documented as far back as 1895.Then conservative management (physiotherapy) gained traction with ACL reconstruction becoming the standard of care if surgery was required.

ACL reconstruction involves rebuilding your torn ligament with an:

  • Autograft – tissue taken from your own hamstring, patella tendon or quadriceps tendon
  • Allograft – donor tissue
  • Synthetic graft – the most common being the LARS graft.

Recently, though, there’s been a resurgence in primary ACL repair, thanks to modern methods of arthroscopic surgery. While it does not suit everyone, for the right patient, ACL repair may be advantageous because it may:

  • Preserve your tissue
  • Maintain proprioceptive function
  • Have higher potential for early healing
  • Be augmented with a graft to strengthen the repaired ligament
  • Result in better functional outcomes.

I am proud to be one of the few surgeons in Australia offering modern ACL graft repair and one of the first in WA. For patients with proximal ACL tears, ACL repair is far less invasive than ACL reconstruction. That translates into a swifter recovery and faster return to normal daily activities.

Learn more about my work in modern ACL repair

ACL repair complications

All surgery carries some degree of risk. For knee surgery, the risks may include:

  • Surgical site infection (prevented or treated with antibiotics)
  • Blood clots (you may be given medication if you’re at higher risk)
  • Pain at the graft site
  • Ongoing instability if the surgery does not succeed – revision surgery is necessary in a small percentage of patients.

A good surgeon will ensure you understand the risks before you consent to surgery and that you have realistic expectations of what a successful recovery may look like.

Navigating ACL rehabilitation

After an ACL repair surgery, we focus on obtaining early range of motion and managing swelling. A knee brace may be used to lock your knee in an extended position and support weight-bearing for the first few days, but you can walk without this and without crutches as soon as you’re comfortable to do so.

Rehabilitation may follow a similar process for both ACL repair and reconstruction. We have found in our patients who are undergoing ACL repair, they tend to reach their rehabilitation milestones more quickly than traditional ACL reconstruction.

Perhaps the best tip for navigating ACL reconstruction is to ensure you have the support of a skilled physiotherapist who works alongside your surgeon.

Throughout your knee rehab, I encourage you to:

  • Ask questions
  • Express your feelings (rehab can be frustrating!)
  • Follow your recommended rehabilitation plan – you can slow your recovery by doing too little and by doing too much and triggering reinjury.

View my ACL rehabilitation protocol

to learn more about ACL rehabilitation exercises

Athletic patients are always keen to know when they can return to sport after ACL surgery.

I emphasise a timely return to sport to reduce the risk of reinjury. I do not want patients to rush back onto the playing field before they’re physically and psychologically ready. For under-18s, this will usually require about 12 months, possibly reducing to around 9 months for older players.

Though you may be keen to know a timeframe, it’s often better to think in terms of goal-based recovery rather than time-based recovery. That would mean you return to sport when your knee meets set criteria regarding range of motion and strength, for example rather than at an arbitrary time after surgery.

Markers of successful rehabilitation that would be likely reduce your risk of reinjury include:

  • Quads strength within 10% of your ‘good’ side
  • Four single-leg hop tests within 10% of your normal side
  • T-test agility drill in under 11 seconds.

How can I help?

With my colleagues at the POSM Research Institute, I am excited to be leading research into ACL repair to increase treatment options for patients.

In time, I hope that patients with ACL injuries will benefit from at least 3 options for their care: conservative treatment, ACL graft repair and ACL reconstruction.

If you’ve injured your ACL and would like advice from an experienced orthopaedic surgeon with extended expertise in knee surgery, please make an appointment today.

 

Disclaimer

All information is general and is not intended to be a substitute for professional medical advice. Any surgical or invasive procedure carries risks. Dr Ross Radic can consult with you to determine if a particular treatment or procedure is right for you. A second opinion may help you decide on your options.

References

For all appointments and enquiries, please contact us on: Tel: 08 9212 4292. Email: radicadmin@perthortho.com.au Alternatively, please call the switchboard on 08 9212 4200 and ask for Dr Radic’s rooms.

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