ACL tears and sprains are one of the most common sports injuries I treat in my practice.
ACL rehabilitation is usually a long process, I will not lie to you. If you are an athlete wanting to return to sport, it will take between 6-9 months maybe even a year to return. Professional athletes may take less time because it is their job to get back to the sport.
A big thing to remember is to not rush it or push too hard. You will need to put in work; however, you do not want to hinder yourself by pushing too hard to get back. Allow yourself to heal properly.
I am going to go through the process of rehab for an ACL repair, meaning surgery to fix the ligament. Rehab for an ACL sprain is very different, and I will post about that later.
What is the ACL?
The ACL or anterior cruciate ligament is a very strong ligament in the knee that connects the thigh (femur) and shin (tibia) bones together. It helps to stabilize the knee during activity.
How does an ACL tear happen?
The most common type of ACL tear happens when sudden stops or changes in direction occurs, and the ACL is unable to stabilize the knee. It specifically happens when the tibia moves too much during an activity. Do you remember the Super Bowl with Odell Beckham Jr’s injury?
Types of ACL Repairs:
- Autograft: the repair that is used is from your own body!
- Patellar Tendon Grafts are the most common that I treat. The surgeon takes a piece of your tendon from the middle 1/3 and uses that as your new ACL.
- Hamstring Graft: a portion of your hamstring is used.
- I have also heard of using the quadriceps muscle and even the IT band, but I have never treated those types.
- Allograft: this type of repair is from a cadaver donor. Not your own body.
The decision on what type of graft to used is something you will discuss with your surgeon. But the most I have seen are the Patellar tendon autografts.
Precautions:
Precautions are the rules you must adhere to following the surgery.
For patellar tendon grafts, you are not weight bearing on the injured leg for 6 weeks after surgery, meaning crutches will be your best friend.
If you have another graft, most likely you can bear weight but not fully.
You will also need to wear an extension brace for several weeks. This brace will help keep your knee straight while you heal. After the first 6 weeks, a sport brace is used.
Post-Surgery:
Week 1:
You will be bandaged up and given that extension brace that I mentioned earlier. You will be told to elevate the leg and apply ice to decrease post-surgical swelling.
Some surgeons may send you to PT at this time, but others may wait. With one specific surgeon I work closely with, the patient does not attend PT until 3 weeks out from surgery. Others I have seen a few days later.
No matter when you attend PT after surgery, we will work on straightening the knee by getting the quadriceps to activate.
Weeks 2-6:
The first few weeks is primarily focused on getting your quadriceps muscle to contract and improving your extension or knee straightening. We will also focus on flexing (bending) the knee as you are able depending on the graft used.
If you had a patellar tendon graft, we do not bend the knee past 90 degrees until you reach 6 weeks after surgery. This is due to the patellar tendon also needing to heal and bending the knee puts too much stress on the tendon.
If another graft was used, reaching full range of motion of the knee is attempted during this first 6 weeks.
There will always be barriers to rehab and every patient is different. Do not compare yourself to someone else with the same injury. Focus on getting you better.
Next week, I will talk about the next phase of the rehabilitation process for ACL’s 6-12 weeks.