So you’ve torn your anterior cruciate ligament (ACL)? It’s certainly not a stroke of good luck, but fortunately, the prognosis for ACL recovery is great.
If you’ve completely torn or ruptured your ACL, surgery is a likely recommendation by your care team. Some torn ACLs can recover without surgery with some good ol’ fashion hard work. However, a fully torn ACL likely won’t recover completely. If you want to get back to your active lifestyle and participate in high-intensity sports, you will most likely require surgery. The reason being: without surgery, your stability and function will remain compromised.
Here’s when surgery may NOT be required for your torn ACL:
- The tear is mild or partial (Grade 1 or Grade 2 ACL tear). A Grade 3 tear is when the ligament has been completely torn.
- Your knee is stable during everyday, low-impact movement (walking, stairs etc.)
- You do not live (or anticipate living) a very active lifestyle.
- You are willing to give up high-intensity sports (e.g. soccer, football, hockey volleyball)
According to Dr. Nima Mehran, LA-based orthopaedic surgeon with experience taking care of collegiate and professional athletes, the last point is the most important when deciding if you want surgery. If you are not very active and are willing to avoid high-impact, cutting/pivoting sports (like basketball, football, soccer etc.) then you may opt out the procedure. However, if you plan to return to your fully active self and participate in high-intensity sports and exercise, you should probably bite the bullet.
Read more about ACL tear basics, symptoms, and your prognosis.
ACL Surgery: What Does it Look Like?
If you’ve completely torn your ACL or have partially torn it but are very active, your physician may recommend ACL surgery. Before moving ahead, your primary physician or orthopaedic surgeon will recommend x-rays to look for any fractures. They also may recommend an MRI to better evaluate the extent of damage with your ligament injury and to assess the best approach for treatment.
In addition, the Lachman test will be performed. The Lachman test is a movement test (flexion) of the knee to see what state your ACL is in. The test is designed to see levels of instability in your knee. The Lachman test is said to be very accurate in assessing the severity of ACL ruptures.
If the tests performed by your care team suggest that surgery is your best bet, it’s time to get ready for surgery.
Getting Ready for ACL Surgery
Are you familiar with the idea of “PreHab”? If not, PreHab can be thought of as “rehabbing” before surgery. In other words, PreHab means employing all of the proven methods to jump-start healing. This means getting as prepared as possible before surgery with physical therapy, diet changes, mental health practices, home prep, and more. By working through a complete PreHab program in the weeks leading up to surgery, you will be more prepared on surgery day, have a better outcome, and can speed up recovery time.
PeerWell offers a daily PreHab program for your smartphone that helps you reduce surgery risk and improve your recovery. PeerWell’s ACL PreHab program helps you get ready for surgery by:
- Improving the strength around your knee and your pre-op range of motion (pre-op range of motion is a strong predictor of post-op range of motion).
- Giving your body the proper nutrition to get a head start on healing.
- Boosting your mental resilience to lower anxiety, and build a drug-free resistance to pain.
- Preparing your environment to fit your recovery so that you can recover in a safe, stress-free way.
The more mentally, physically and environmentally prepared you are on surgery day, the lower your risk. The risks that go along with ACL reconstruction (although quite low) include: infection, difficulty with pain control, stiffness, blood clots and being physically unprepared to heal. All of these things can be managed with solid, daily pre-surgery PreHab program.
ACL Reconstruction Surgery
ACL reconstruction surgery and ACL repair surgery are not the same thing. ACL repair surgery refers to when the patient’s native ligament is repaired. This is usually possible when the ligament tears directly off the femur (thigh bone) and is able to be reattached. The vast majority of ACL surgeries are reconstructive in nature. This reconstruction uses a graft to build a new ACL ligament. There are a few different types of grafts used and can be taken from your body (autograft) or donated from someone who has passed away (allograft). ).
Typically, ACL surgery is a same-day (outpatient) procedure. It will either take place in the hospital or in an outpatient surgery center (also called an ambulatory surgery center).
Here’s a breakdown of what the surgery looks like:
- You are given regional or general anesthesia. You are either completely unconscious during surgery or under heavy sedation with regional anesthesia.
- Surgery is “arthroscopic”. This means that instead of a large incision cut down the front of the knee, several small incisions around the knee are made. The arthroscopic method is preferred because it allows for faster healing, is minimally invasive, lower risk, and is easy for your surgeon to work with. However, if you’re providing the graft for surgery, you will have a larger incision from wherever the graft was taken.
- Saline solution (salt water) is pumped through an incision mark to wash out the area. This gives your surgeon greater visibility.
- An arthroscope (a camera) is inserted through the incision to transmit the inside of your knee onto a monitor.
- Small holes are then drilled into your upper and lower leg bone. These drill holes will be used to securely anchor the graft (replacement tissue) in place.
- The replacement tissue is then weaved through the drill holes and anchored in place. The graft is secured with screws, a button, or rarely staples (which are very uncommon).
- Finally, the incision is closed with stitches, staples, and/or tape. The incision site will be bandaged and you will be taken to a recovery room. You will likely be released to home in the same day.
Recovery From ACL Surgery & What to Expect
After surgery, it will take several months for you to get back to 100%. However, you will notice major strides being made within the first few weeks. For most people a complete recovery takes 9-12 months. It is a marathon that takes dedication and perseverance. Consistent physical therapy and a complete at-home ACL ReHab program will be necessary to get back to your former range of motion, strength, stability, and activity levels.
Here’s what the first few weeks of ACL recovery may look like
- Focus on controlling pain.
- Sticking to your medication regimen.
- Trying to reduce swelling with icing and elevating your knee.
- Keep your incision dry, clean, and intact (you don’t want them to become overly wet or bloody).
- Achieving early range of motion (ROM).
- Fully engaged with physical therapy and ReHabbing your knee.
- Going to your appointments (post-op check-up and outpatient physical therapy).
- Achieve full extension by doing your passive and active extension exercises.
- Start getting back to your normal life.
- Safely walking on crutches and beginning to wean off of them.
- Focus on regaining muscle control and rebuilding your ability to move.
- Work hard in physical therapy (exercises for extension, quad strength and beginning your muscular control routine).
- Control swelling by icing and elevating your knee.
- Begin to wean yourself off crutches (talk to your physical therapist about doing this safely).
- Put full weight on your affected leg.
Week 4 and Beyond:
- Begin to regain motion of your knee (this usually happens between the 4 to 8 week mark). However, some people may not regain good range of motion for up to 3 months. Although this can be difficult, generally, it isn’t cause for concern.
- Wear your brace while sleeping and walking until your physical therapist or surgeon says you can remove it (usually around 4-6 week mark).
- Start driving again (usually between 6-8 weeks). Your surgeon will have to sign-off before you start driving. You can absolutely not operate a car if you’re still taking narcotics
- Continue with physical therapy and rehab until you regain full and normal function. This can take 6 months to one year. Once you are completely healed and your surgeon gives you the go ahead, you can slowly reintroduce higher-intensity activities.