What Happens After ACL Surgery?

lower leg
ACL tears are a common injury among athletes. At most risk are female soccer players in their teenage years.
Unfortunately, when an ACL tear occurs, most of the time surgery is required due to the inability for the ACL to heal itself. Rehab is long and necessary, but there is a light at the end of the tunnel. In most cases, following the appropriate amount of time you can return to activities you were doing before, however patience is required.

The ACL is a ligament helping to stabilize the knee, and most commonly is injured in knee twisting motions, or a forceful hyperextension of the knee joint.

After the injury occurs, a MD or Orthopedic Specialist will evaluate the knee and determine its stability. If the MD discovers the knee is lacking appropriate stability due to a tear, the the type of ACL graft has to be determined for the reconstructive surgery. The patient will consult with the surgeon to determine if an Autograft (patient’s own hamstring or Patellar tendon) or Allograft (use of a cadevor) will be used. Then typically a surgery date is set, and until the surgery the patient should maintain as much range of motion and strength in the injured leg as possible, while not overdoing it at the same time.


Phase I (Day 1- Week 4)


Typically ACL reconstructive surgery is performed in an Outpatient facility, and an overnight hospital stay is not required. For the first few days following surgery, safe range of motion is most important. Sometimes a machine (CPM) is ordered to help slowly improve knee straightening and bending. During this time ambulation is in small amounts, and crutches are used the first few days. Typically this means short walks around the house. For example, to and from the bathroom and slowing building from there. Physical Therapy starts during this time as well. A Physical Therapist will help improve range of motion, as well as isometric quadriceps and hamstring strength. The therapist will also encourage weight bearing on the injured leg, and begin to wean the patient from the crutches as appropriate.


Phase II (week 4-10)


During these weeks the range of motion and strength will continue to progress, as well as safe single leg balance and stability to begin work on proprioceptive training on the injured leg. The therapist will also work with the patient to establish normal gait. Safety is crucial during this time as range, gait and strength return to normal. As the patient begins to feel “normal” again, typically they return to more activities. It is important for the patient to be aware during this time that the ligament does not full integrate and heal until approx. 6- 8 weeks following surgery. The risk for tearing the new ligament is high during this time if a patient begins too many activities too early and does have the appropriate strength to protect this healing ligament.


Phase III (week 11-24)


Dynamic balance and stability is progressed in this phase. A physical therapist will concentrate on ensuring good single leg strength and stability, as well as continued proprioceptive training. Range of motion should be full at this time, and the patient should be returned to normal activities of daily living. The patient should have a thorough home exercise program involving balance, strength, and stretching for progression to independence from Physical Therapy.


Phase IV >6 months


During this time more sport specific training is incorporated to prepare the athlete for return to sport if appropriate. Strength and range of motion should be full, and a patient should feel confident in single leg dynamic motions. A brace will be used when the patient returns to sport to prevent future tears.


This is a typical guideline following ACL surgery. Sometimes modifications are needed and the healing time varies depending on the extent of injury and if there are other involved structures. In my experience, for best results it is important for the patient to be compliant with the home program without overdoing, as well as keeping good contact with the Surgeon and Therapist. I have had many patients return back to sports, but usually the hardest time mentally is in the third and beginning of the last phase when the strength is not quite ready for full participation and the patient still has to hold back. Patience is key during this time for a good outcome. If you have any questions as always just e-mail me: berryhappybodies@gmail.com

Contributed by Dr. Alison Cupini, DPT


References:

1. Kisner, C. Colby, L. Therapeutic Exercise Foundations and Techniques. Davis Company, Philadelphia. 2007.

2. Levangie, P. Norkin, C. Joint Structure & Function A Comprehensive Analysis. Davis Company, Philadelphia. 2005.

3. Maxay, L. Magnusson J. Rehabilitation for the Postsurgical Orthopedic Patient. Mosby Elsevier, St. Louis. 2007.

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