22 Nov What to Expect After ACL Surgery
Most people who undergo ACL replacement surgery are active individuals looking to return to their specific sport. The first question that is on many people’s mind when discussing the rehabilitation process, is “How long will it take?” And, the response is not as easy as it may seem, because there are often multiple factors that contribute to the answer. Generally, a high-level to intermediate recreational athlete should expect around 9, if not 12 months. Yes, 9 is the earliest that one should expect, not 6. The quickest a professional athlete will safely be able to return to play is in 6, and most people who sustain ACL injuries are not even close to that professional level (be honest with yourself). The reason that those athletes MIGHT be able to return at 6 months is because they complete rehab all day, everyday. Most everyone else is spending 30 minutes to 1 hour, 5 days a week realistically (if you’re being “good”). While working with the University of Connecticut Men’s Basketball team as an intern, we safely returned several athletes to competitive play post ACL reconstruction surgery in 6-7 months, but their daily routines included:
– 1 hour of conditioning (bike, elliptical, swimming, as tolerated within protocol guidelines)
– 1 hour of therapeutic exercises with the supervision of an Athletic Trainer or Physical Therapist
– 1 hour of pool or reformer (additional to complement manual therapy and land exercises)
– 45 min -1 hour of manual therapy (including soft tissue massage, joint mobilizations, deep tissue release, tactile cueing, etc depending on phase of recovery and individual needs)
– Multiple sessions of electrical stimulation + ice + compression especially during the early weeks
In total, they are spending 5-6 hours a day recovering from their surgery, while the majority of us simply are not able to dedicate time like that.
Also remember, there are a few different graft choices that one may pick from which will affect the rehabilitation process and likely the timeline as well. The most common options are, patellar tendon autograft (your own tissue) hamstring autograft, or an allograft (tissue from a cadaver – achilles tendon, patellar tendon, anterior tibialis, etc). You should plan to discuss this topic with your surgeon to determine what graft is most appropriate for you. Some basic rehabilitation factors to consider for each are:
Patellar tendon autograft:
– Potential difficulty in quad activation during initial phase
– Increased risk of patellar tendonitis
Hamstring autograft:
– No hamstrings activation for ~4-6 weeks to allow harvest site to heal
Allograft:
– Slightly slower rehabilitation timeline to allow new tissue to integrate (up to 12 mo)*
* Vyas D, Rabuck S, Harner C. Allograft anterior cruciate ligament reconstruction: indications, techniques, and outcomes. JOSPT. 2012; 42(3):196-207.
The other major factor that affects timeline is co-morbidities. Now, what are those? They can range from a medial collateral ligament sprain (MCL), a medial meniscus tear (if both occur and are combined with a rupture of the ACL, it is called the “unhappy triad”), a lateral meniscus tear, cartilage damage, a bone bruise, and the list goes on. These additional injuries can alter your timeline considerably, so take that into account and give yourself a break!
Basically the take home message is that you are an individual who will take certain steps outlined in generic protocols, however you should have a team including your Physical Therapist that will be constantly re-evaluating your range of motion, muscle activation, biomechanics, and strength (to name a few) to make sure that you’re “covering all your bases,” and progressing as you (and you alone) are able.