Having ACL surgery is a big commitment. It is a painful procedure with a long-anticipated recovery. As your surgeons, we know all of you have one goal in mind, returning to sports after your ACL reconstruction. The research around the return to sports after knee surgery has been studied aggressively for decades. We have great statistics and great rehabilitation programs to guide you. Many of you will try and rush your return to sports too soon. If you attempt to return to sports too soon after ACL surgery then you run the risk of tearing or re-injuring your new ACL.
Below are 5 expert Sports Medicine opinions about when an athlete can expect to return to sports after having an ACL ligament reconstruction on their knee.
A successful return to sports after ACL surgery is your number one goal. There are many variables that go into determining when you should try to return to sports after ACL surgery. The risks of returning to the playing field too early after ACL surgery include suffering a re-tear of your new ACL. A successful return to sports after ACL surgery requires a team approach. It involves you, your surgeon, your athletic trainer and your physical therapist. We have very strict criteria for when an athlete can return to sports after ACL surgery. If you attempt to return to sports too soon you have a significant risk of tearing your new ACL.
Related reading …
- Physical Therapy and ACL Injuries
- Can I return to sports after ACL surgery?
- Risks of reinjury after ACL surgery
The statistics can be alarming. You might have a 45% risk of tearing your new ACL if you have not rehabilitated your knee properly. You can drive that risk down to 18-20% with the proper training. Unfortunately, once you tear your ACL you are always at risk of tearing the new ACL.
The first goal of your physical therapy after ACL surgery early on is to get back your motion and strength. The later stages of the recovery process involve improving your balance, agility, jumping and landing skills. Doing so will decrease the risk of re-injuring your knee and re-tearing your ACL. Your recovery from an ACL reconstruction involves not only the physical aspects of your recovery but perhaps equally as important, the emotional and psychological components. We will get into this in more detail in a later series with many experts who specialize in rehabilitation of ACL injuries.
The research regarding the immediate management of an athlete after ACL surgery continues to evolve. It turns out that immediate PT might weaken your new ACL graft. Some surgeons are starting physical therapy a week or two after surgery because of this research. Once PT has started, the research today shows that many people will tolerate an accelerated ACL surgery physical therapy program and be able to return to sports as early as 8 months. There are many experts who feel that might be too early. Thus there is a lot of confusion on the proper way to return to sports after ACL surgery.
What criteria do our experts use to determine when you might be able to return to sports after an ACL reconstruction? Once again we have asked our panel of ACL experts to offer their insights.
How Do You Manage Your Athletes After ACL Surgery … and
When Do You Let Your Athletes Return To Sports After ACL Surgery?
S.S: My ACL surgery post-op protocol involves brief ( about 7 days ) immobilization of the knee in full extension and full weight bearing as tolerated. In some animal studies done at HSS, a short period of post-op immobilization leads to better quality ACL graft biologic tendon to bone attachment. In addition, this has helped me encourage patients to achieve early post-op full extension of the knee, which is very important. After about 7 days, I remove the brace and start physical therapy to reduce swelling, get full range of motion and start isometric strengthening progressing to closed chain lower extremity strengthening. I modify this program for patients with a meniscus repair or a multi-ligament reconstruction. I will allow patients to start a running program at 3 months if they can pass a series of four, simple to administer, functional tests. These tests were developed by a joint group of orthopedic surgeons and physical therapists and were published in a special issue of the journal Sports Health. During this time they continue to work on strength and neuromuscular control.
D.G : I work very aggressively to have the patient regain full knee extension in the first few days or at least a week or two after surgery. I also have them work with the physical therapist to regain quadriceps strength as quickly as possible. I tend to allow full weight-bearing unless I perform a repair of a bucket-handle meniscus tear. Otherwise, I use a fairly standard protocol, usually restricting jogging for 10 to 12 weeks after surgery and progressing to sport-specific activities in the coming weeks.
D.O : Initially, start physical therapy within a week. Unless I need to perform a microfracture, I typically do not use a continuous passive motion machine (CPM). Icing after surgery is a great pain reliever. The compression ice machines work great, but typically they are not covered by insurance. A frozen bag of peas can work pretty well in its place.
As you can see, determining when to return athletes to sports is a challenging issue. We want to limit your risk of re-injury as much as you do. Routine bracing after ACL surgery is not proven to be necessary. We also differ slightly when it comes to rehabilitation immediately following an ACL reconstruction. It turns out, as Dr Slattery pointed out, that waiting a while before starting PT might be of benefit by allowing your new ligament to start to heal. Stressing full extension as Dr Geier pointed out is critical.
Bottom line.. do not rush your return to sports. Get that leg and your mechanics and stability as close to normal as possible. It will be time well spent.
Our Experts:
D.G.: Dr David Geier : Twitter: @DrDavidGeier ; Website
J. B.: Dr Jeff Berg: Twitter: @DrJeffBerg ; Website
D.O.: Dr Derek Ochiai: Twitter: @DrDerekOchiai ; Website
S.S: Dr Scott Slattery: Twitter: @sportscaduceus ; Website:
Miilo lai
Hi doctor ,
Its almost 4 month of acl surgery and i have start jogging but during jogging sometime there is little pain where the knot is used to hold the acl …is it usual or is there any problem ….and i am thinking of start light soccer playing …is it will be ok doctor ?
It’s definitely not time to start playing soccer. Read up more about the Melbourne ACL Rehab or the MOON group ACL protocol.
Your chance of re-injuring your ACL is too high if you go back to sports now
Olivia
Hi, I am 16 and I tore my acl and meniscus about a year ago in a soccer game, but I had my surgery about 10 months ago. I have missed most of club soccer and high school soccer. A few weeks ago I was on track to get back into contact, and I was so excited, it was feeling really good at practice and I was starting to feel normal again. But about four weeks ago I was doing a drill in soccer practice and I planted my leg and heard another pop. This was so scary for me, I didn’t know if I had re torn my acl. It didn’t hurt nearly as bad as the first time and I could walk right away after. We got another MRI and all the ligaments looked good. Since that incident it has happened four more times were I feel a pop in my knee followed by pain. This feels like it could be a huge setback and I don’t really know what is going on. My doctor is planning on doing a scope surgery in about a week, to try to clear out meniscus and scar tissue. Have you ever seen this happen to another athlete/can you explain to me what is going on. Thanks.
HI Olivia…
I’m sorry to hear this. All I can say is that our exam will usually tell us if the ligament is working well. Sometimes people form scar tissue in the front that we call a cyclops lesion. That should be obvious on the MRI. Sometimes it looks intact on an MRI but our exam shows it may be loose. Unfortunately, without examining you I cannot tell you for sure what’s going on. I would strongly consider a second opinion before another arthroscopy. The diagnosis should be clear before surgery.
Denise
Hello, my daughter torn her ACL playing high school soccer and she had a ACL reconstruction surgery at the beginning of November using her hamstring. She is a multi sport athlete ( soccer and softball ) Her most favorite sport is softball. She is now almost 6 months in her recovery and she is doing well. Still sees her PT every other week to monitor her progress. What do you usually clear a softball player to start doing again after 6 months
and when do you think she will be able to return to play in softball games again ?
We are actually getting longer and longer in terms of when we clear athletes to return to sports. 6 months is far too soon by most research standards. For kids under 18 many of us wait a minimum of a year, or more. There are strict return to sports guidelines and tests that a solid physio can perform on her. The risk of re-rupture is simply far too high if she returns too soon. The risk can be as high as 50%. Sadly the risk never goes below 16-18% even in the best of circumstances.
Jason R.
Hello,
First of all, great article. I am 50 and a 3rd degree black belt. In January I tore my ACL and lateral miniscus. I had surgery the first of April with a cadaver replacement ACL, repaired meniscus, and some general joint cleaning. The surgeon is a sports orthopedic surgeon. Therapy is going great. PT said I’m actually ahead of schedule. What do you think my chances are of being able to continue to train as I once did?
Thank you
There’s a good chance that you will be able to return
Stephanie
Hi- my 14 yr old son tore his acl in August playing foot ball, and had surgery in September. He’s just started back jogging and is slowly being introduced to agility drills. Surgery and rehab have been great up until now. The doctor has him in the don joy defiance brace for return to sport for 2 years. My son hates it! He said he’d rather not play sports than have to wear the brace. I’ve read on the comments above you do not recommend bracing, but do you put your pediatric patients in a brace for return to sport? Dr says it’s for confidence and propioceptive reasons, but at this point it’s making my son more agitated and he doesn’t want to do rehab. Thanks ahead for any insight you can shed.
it’s a very controversial topic. Most of us wait a very long time before letting a 14-year-old return to sports. We will hold back most for a year or more. Their risk of reinjury is simply too high. Anyway … I really can’t answer your question about the brace. There’s certainly no consensus opinion on using a brace…. and the research is not clear either.
Good luck to your son!
Matthew Cooper
my son tore his ACl and Meniscus October 5,2017 . He had acl surgery and took the test to resume play after 8 months of intense therapy He got a 97 on the test to return. His 1st day back to football he tore everything again with a basic run and cut move with no equipment or contact. should he give football up bc it will happen again? Whats happens if you tear it 3x? He was being recruited by D1 schools. He is going to be a junior this year. He is out until july 2019. Thanks for your advice Please reply
HI Matthew …
I am sorry to hear of your son’s reinjury. These can be devastating injuries.
Return to sports (RTS) after an ACL tear is a very complex and hotly debated topic. Many of us are going longer and longer now before letting athletes back on the field. But the pressure on us is intense. Coaches, parents and athletes are trying to push the recovery shorter. We may allow training to begin at 8-9 months, but often delay return until 1 year or more. We don’t really score the physical component of the RTS criteria, but we do score apps like the ACL-RSI which tell us if the athlete feels emotionally ready to return.
Mick Hughes ( https://twitter.com/mickwhughes ) out of Melbourne has a tremendous amount of information online about his criteria and RTS program. It might be worth looking into.
Mitigating risk with RTS include:
Graft choice .. NO allografts in kids, Patella Tendon likely best graft for football.
Strength
Conditioning
Heavy load training
agility work
Most of use the MOON protocol or the Melbourne Protocol for getting an athlete back. But they are not the only programs out there. There are also specific ACL rehab specialists such as Julie — https://twitter.com/julie_eib — who are very well respected in this area.
Unfortunately tearing the same ACL twice puts the knee at higher risk for yet another injury. D1 prospects tend to fade after a second ACL on the same side. There is also an argument to be made to stop playing football to minimize the risk of further injury and thus try to minimize the risks of developing severe arthritis at a young age. This is a complex and difficult topic. I am sorry that you and your son are going through this. Do your research before proceeding further … There’s a lot to learn out there.
Howard Luks
Kelly Vega
My 17 year old son tore his MCL and ACL during a football game. We have been told he needs an ACL reconstruction surgery. Is there much of a difference in outcome between a Minimally Invasive ACL Reconstructions vs the standard Arthroscopic ACL reconstruction surgery? Thank you! Your information on return to play was very helpful.
HI Kelly….
All ACL reconstructions are arthroscopic and by definition minimally invasive. The success of an ACL reconstruction with a 17 year old athlete will depend on :
1. Surgeon’s experience…. the surgeon needs to perform many, many ACL reconstructions per year.
2. Graft choice… a lot of scientific literature showing that allograft (cadaver) is not a good choice in this age group.
3. Proper pre-hab : Rehab before surgery improves response to rehab after surgery.
4. technique … a good surgeon will get the graft in its proper place far more often than an inexperienced surgeon.
5. Rehab and adherence to strict return to sports criteria …. it usually takes 8-12 months to be able to pass the tests.
the length of the incisions is meaningless and often a marketing/ selling point — but has nothing to do with the recovery or rate of return to sports.
Good Luck
Brady Brockhaus
Hi Doctor! I am a Senior in high school and I have a very important question. I tore my ACL last year in the last football game of the season and had ACL reconstructive surgery using my hamstring graft. Basketball is my favorite sport and I am receiving college offers to play. I have started since I was a Freshman. I had to miss my junior year of basketball and was eventually cleared in August to play football again. In the third game this season I tore my reconstructed ACL. I tore my ACL and a slight tear in my lateral meniscus. My very important question is, Is it possible for me to play basketball and have surgery after basketball season? Or is there anyway I have surgery now and make it towards the end of the season? I know there is risk playing on a torn ACL but I just wanted to know if it was a possibility? It is my senior year and it is my last chance. Your thoughts? Thank You!
There is risk involved if playing on an ACL deficient knee. That being said, there are people who have finished an in-depth ACL rehab program and returned to sports without ACL surgery. The risks include cartilage damage and meniscal tears, both of which will significantly increase the risk of developing arthritis.
Julia Mendes
I tore my acl playing soccer September 2016 then later had surgery in October 2016. I had some problems getting my full range of motion back and it took me up until december 2016. Since PT has been such a pain i just now recently am getting back into jumping currently. Next week i have an appointment with my doctor to check if I am cleared to return to sports and since soccer starts next week, I really wanted to be able to play. Do you think i will be able to return?
I hope so :-) It depends on your agility testing that the doctor performs. We have many tests that we ask athletes to complete before we allow them to return to play.
Jon
Hi doc! I have a high grade tear of the acl is seen towards the femoral attachment with mild anterior translation of the tibia. Mildly displaced fractures of the posterior part of the lateral tibia plateau are noted with sorrounding marrow edema , subchondral cystic changes and high grade chondral loss over the surface.
Peripherally place vertically oriented tears of the posterior horn of the medial miniscus extend up to horn body junction as well as the lateral meniscus involving the posterior horn and posterior horn body junction are noted.
Doc when i consult that to the ortho he told me that i dont need surgery because i dont have any issues regarding the stability of my knee like sign of locking and buckling of my knee.. so i ask him if i can still go back to sport after surgery then he told me i have slim chance of going back to sport even i do the surgery..
Doc is it true i can not go back to sports again?
HI Jon…
I wish I could answer that question for you… but without talking to you and examining you I can not offer medical opinions or advice.
Ruming
Hi, I’m 18 years old and had just undergone my second ACL reconstruction. I’m a competitive female basketball player. The first time (2014) I torn my ACL, LCL, Meniscus and chondrol injury. This time (2017) I torn my ACL graft which is my hamstring graft , having some meniscus tear and chondrol injury again. Doctor suggested me to use allograft this time instead of patellar tendon graft. I’m aware that the re ruptured rate of allograft is much higher than autograft , however I still choose to go for it as I’m afraid I might have cause more problem to my knees if I go for another autograft. Besides, my doctor used staples instead of screw to fix my new acl in place. What I’m concerned is will this affect the strength of my new graft?Or the amount of load can my new graft stands? Moreover, I wonder what is the best timeline for me to start running, jumping and carry out pivoting exercises? As I’ve met quite a number of physio centre which have different recovery programs for their patients. My current physiotherapist is giving me some jumping exercise when I’m in my 7th week post operation. Is it safe to start as early as this? Will you encourage your patient to do so if they have no pain while doing these exercises? I’m really concerned about my knee condition. I wouldn’t want to have a 3rd time. Thanks.
Great questions… Because this is a revision AND because they used allograft you should not push this very quickly. A stapled graft is much longer than a normal graft too… so that means that it can stretch.
I would talk this over with your surgeon if you are concerned about how fast you should progress.
raghu vaidya
dear sir am raghu 30year old from india i had acl reconstruction surgery in 2008, after that i tried to play cricket and som other sport but my knee loosing stability when am giving force on the leg still am facing problem and usually i do every day workout but after leg workout i cant walk like that pain am getting
Perhaps your new ACL is not functioning well. I would see your doctor again. Or possibly a second opinion.
TimH
Hi, Here’s a good one for you! In December, 2016, my daughter (18 years old) and tore her patellar tendon off the knee cap (80% tear), her ACL, lateral meniscus, medial meniscus and Patellar femoral ligament – all in one shot, playing basketball. Due to this, she had two surgeries – first was to reattach the patellar tendon to the knee cap. Then, we waited 9 weeks after that surgery and then had the ACL reconstruction done using a portion of the patellar tendon that was just repaired. She’s 8 weeks post op and doing great in rehab. No impact exercises for a total of 4 months and then will go back to physical therapy and working on the twisting, balancing, agility, etc. I read some of your posts about ACL Prevention Classes. Can you give a little more info on what this is and where can she get this? Also, she will be 6 months Post-op come September, 2017 and will be starting to play D1 womens lacrosse in college. Would you recommend not playing ‘Fall Ball’ and giving her an extra 4 months of therapy and healing prior to her Real season starting in January, 2018 or do you think the extra few months wouldn’t be needed as long as she’s cleared?
That is quite an injury.
There are a lot of great programs that administrate ACL prevention courses… check with your local ATC chapters.
Using a repaired PT worries me a bit… 10-12 mos recovery prior to RTP probably a very good idea.
TimH
Thanks for the reply. “Using a repaired PT worries me a bit …” Is the concern that the PT will rupture again or the ACL will rupture?
Robert Barnes
so my son strained his acl he tore his meniscus on both side and fractured the patella he didn’t have surgery and the doctor immobilized his knee for a month after that he did physical therapy and doctor released him back to sports as long as he would wear the ACL brace which he has but earlier this week he was at the beech running in the water and his knee gave out and he heard a pop what do you think happened his knee is swollen but not awful he is feeling weird and doesn’t know whether he did something that is worth going to the doctors for.
Definitely worth being evaluated. A good sports medicine doctor should examine that knee to be sure that the ACL is functioning properly.
Good Luck
Melvin Debinarain
Hi Doctor
I am a 43 yr Male . I had an ACL op about 2 years ago. I recently started playing soccer again. Just love the game and can’t stand just watching. I have started playing a few times now. The problem is that after playing, the ACL op Right knee starts to swell and sort of locks. Can not bend it fully the next day. Pain also occurs at times. During game nothing funny occurs, all goes well ACL knee holds up well. Just the after effects not good.
Why is this happening… When should I do…any medication can help. I notice after about 2weeks all is back to normal. Please assist.
Time for a good exam, X-rays and perhaps a repeat MRI to assess the integrity of the menisci. The X-rays will also show if some arthritis is developing which can cause these symptoms.
Karen Ceseretti
Hi Doctor,
My 15 year old daughter tore her ACL on her right knee and had surgery October 2015. She was released March 2015 but I didn’t let her play with any contact until July and that was basketball. She played high school soccer and was doing great, no pain and speed was coming back. We were measured at Michelli Center of Boston Childrens Hospital and both legs measured equally. One week late October 2016 she tore her left ACL. We have surgery scheduled for November 17, 2016 — hamstring ACL reconstruction both times. She is three sport athlete but will drop soccer going forward. She hopes to at least play basketball in college. What is the retear rate? Any suggestions going forward?
I’m so sorry to hear that….
the statistics in this area are still very troubling for us. Most children have an 18-22% risk of injuring their normal leg or the reconstructed leg after their first ACL tear.
Proper training, ACL preventative programs, a season of rest, etc all are important in trying to minimize the risk of a recurrent ACL tear, but the stats are still what they are. I know some parents who have terminated their child’s participation in sports due to recurrent ACL injuries… but that is obviously a very very difficult discussion to have.
Good luck to your daughter!
Bobby
Hi Dr. Luks
I tore my ACL for the second time and will have my reconstruction sometime around november we’re waiting for the holes in my bones to close as my doctor said. Question is there are times that i turn and my knees collapses thrn after that i can barely straighten my leg, i have to do a twisting motion from left to right in a circle pattern to re align it. Is it because i dont literally have a ACL or is it because i have a meniscis tear?
Could be both ??
Mary
16-year old daughter tore ACL playing basketball last fall. Had surgery Dec/15, patella graft. She had physical therapy with ortho office for first three months, took a month off for various reasons, and then did a 10-week program (4 days a week) with sports agility trainer over the summer. At about 7 months, she was allowed to return to volleyball, with the guidance of 50% playing time in a one-night-a-week summer league. At 8 months, with the start of school, she made the varsity volleyball team. She did have some soreness and slight swelling upon this return of volleyball. It lasted about a week, but eventually went down with ice and aleve. She only plays front row (no back row) and rotates in with another middle player. She was feeling good and looking good on the v-ball court. In last couple weeks, she has added some basketball workouts with her travel team (in addition to the volleyball season). Drills, light scrimmaging, full court running. She is looking to play in a weekend basketball tournament in the upcoming weekend. She has been getting some knee pain on the lower, inner part of her knee. We almost had a bit of a scare during the warmups of a volleyball game last week. Her jumped looked awkward (landing was ok) and she had pain…she tried to walk it off, but had to sit out and ice and walk it out. PA checked her out last week and it appears everything is ok and intact. PA did pinpoint the pain to the surgery site (mentioned a screw?). Also said her quads are stronger than her hamstrings? PA gave her some exercises to do and to increase Aleve dosage for about 4 days and we go back in for another checkup soon. This is the appointment where my daughter is looking for a full-release to return to sports.
She has been able to pass therapy tests with her knee above 89% and approximately equal to the other knee. I am extremely worried about her return and how likely would an injury reoccurr? All coaches (volleyball and basketball) seem to be very cautious with her return for which I am thankful. Advice?
Without examining her I can’t really say what’s going on…
Good luck though!
Jaden Dunn
Dr. Like , I’m 16 and I had all surgery on October 8th and went through Physicla therapy and everything , they say I’m good to start slowly returning to sports and everything and using my sports brace for protection but I feel like my knee is still not strong enough ? And idk when I can play my fullest or play without the brace on , what do I do ?
Jaden…
Then you are not ready to return yet. A significant part of the recovery is psychological… feeling that you are ready. You need to have trust in your knee, and your knee needs to be perfectly trained. At your age the risk of reinjury is very high… so make sure that your knee is truly ready to return to sports. I have other posts which link to the 6 agility tests you need to be able to do before being cleared. Strength is not the only thing that matters. Your agility and your confidence in your ability matter more.
Good Luck
Mindy
Yes, femoral. No, block. My Orthopedist tells me that I can’t work any “harder” in PT that I just need to have patience with the quad atrophy. If not progressing by Oct, he wants to do neuro test again. My PT believes the pain to be the MPFL attachment behind the knee and the quad atrophy. My husband and I lead a very active lifestyle. This has been as much an emotional challenge as physical. I am willing to work harder in the rehabilitative process, just need to know what more I can do. I appreciate your response.
Courtney Kirchner
How long after surgery does an athlete usually wear a protective knee brace. My daughter had surgery 2/24/15 and is play college soccer starting this week. So, it’s been 19 months since her surgery to repair her ACL. She doesn’t want to wear the brace, and we (her parents) are concerned. Do athletes typically go without the brace after a certain amount of time? She just finished spring high school season wearing it all the time, and hated it in the rain. She said the trainers told it she didn’t have to wear he brace. Thank you!
Hi ..
Most of us do not brace ACL reconstructions. Braces have not been shown to affect the risk of recurrence. The statistics are what they are: the risk of a second ACL tear or a reinjury to the reconstructed knee is 18->30% depending on how well her rehab went. Bracing has not been shown to diminish that risk. To minimize the risk of reinjury she should be in an ACL prevention class… the research in that are is very clear. Proper prevention techniques and exercises can reduce the risk of injury by 50%.
Mindy
Hello Dr.Luks. I had knee reconstruction on 4/20/16 with ACL repair, meniscus and MPFL using a cadaver graft. I had dislocated my patella playing tennis. Unfortunately, the brace was putting pressure on the nerve and after neurological testing was told I had damage. I was kept in a brace with no weight bearing for several weeks longer than usual. I am still in PT twice/week and have worked up to an hour workout on a spin bike or elliptical. I have taken my road bike on a couple of longer rides (45 miles). No swelling. My nerve appears to be resolving as I have most feeling back. My quad had significant atrophy with the lengthy immobilization. My concern is that I still have instability in my knee. I am walking with a limp and have some pain under the patella particularly when doing one-legged squats. I would like to start jogging, but not sure if advisable. I am nearly 50 and just want to get back to jogging, biking, long walks!
which nerve was injured ?? Femoral? did you have a block during surgery?
Sandro
hello Rob ,
I live in the Netherlands and I play soccer high level, injured my ACL 1,5 week ago..
And now operation is necesary!
They give me 2 choices, or reconstruction or a new way (DIS ligamys, attach surgery). With that 2nd operation, it must take plays 3 weeks after the accident..
I am not sure which One I should chooce, my doctor told me , my knee is not ready yet for surgery, to stiff..
But i dont want to wait 4/6 weeks and then 8/12 months and then re injure myself because of this reconstruction
Any tips?
Many people are choosing to have a repair. It is too early to tell if the results of a repair will hold up as well or better than a formal reconstruction. It will be many years until we have that answer.
Robert B
Hello Doctor Luks, my daughter has a partial tear of her left ACL, the doctor we met with gave a short examination and immediately stated his desire to do a full reconstruction. Prior to seeing this doctor we had taken our daughter to an orthopedic doctor locally where he examined our daughter and gave the original Grade 2 partial tear diagnosis, yet because our daughter is so young he referred us to a pediatric physician. During our wait for this appointment we took our daughter and her MRI to a Physician Assistant/PT who also in confidentiality described the tear as partial. My questions are 1. Is the decision by the doctor who deals primarily with youth based upon criteria the others do not use? 2. My daughter is 11 years old and this is a terrible thing to contemplate, yet is there an underlying issue that would lead such a young child suffering even more of these traumatic events or is this just random bad luck? 3. Would ACL Augmentation be an avenue of treatment that should at least be entertained?
Rob .
Far too many variables in place for me to comment specifically in reference to your daughters care. Her exam and some of the other MRI findings are important considerations.
In general, some truly partial tears can be treated without surgery if (after PT) the knee is stable.
Some partial tears will require surgery if the knee remains unstable, or if the majority of the ACL is torn.
Augmentations are an option, but if at the time of surgery we see that the remaining bundle is damaged we might opt to perform a full reconstruction.
Robert B
Thank you for your timely answer, we shall see what the second opinion is. I have found your website to be extremely helpful yet I wish I had not the reason to search for such! Good luck to you and your patients + families.
Thanks Robert!
Jack
Hello Doctor Luks,
I’m currently 6 months post ACL surgery, using patellar tendon graft. I suffered a non-contact injury during basketball game. My PT is going pretty well so far. I only had some pain in front of my knee cap and in my calf, but it all went away after 2 weeks. I feel like my leg is really stable. My strength is pretty good as well, however, it’s still not the same as on my healthy leg. I talked to my therapist and he told me I’m on a good road to get cleared in about a month.
With all that, I would like to continue my basketball career on a professional level. I’m really wondering and curious about your opinion on knee brace. So far I’ve talked to four doctors/therapists, and two of them told me to wear it, while other two told me not to.
Some of them said a knee brace is good for prevention, it is less likely to get injured again if you wear it during sport activities for at least 12 months after surgery etc. On the other side, some of them said it’s pointless, your movement is not natural on a
court and it doesn’t help to protect you from re-injury etc.
What are your comments and opinion on wearing a brace?
Thank you a lot!
howard2
Braces, in general, have not been found to protect against another ACL tear. They give you a false sense of security.
Alex Gomez
Hi Dr Luks ,
I’m 15 & I tore my acl in September of 2015 & got surgery in November in 2015 & I played football & got cleared of PT a month or a 3 weeks something like that but is their more of a risk of re-tearing it because i kinda got cleared early. Please please reply
If you had an ACL reconstruction and go back to playing sports in one month then you are at a very high risk of reinjury. Look up the Moon Protocol for ACL recovery. I also have a more recent article on my blog. IT describes some of the milestones you must hit before even thinking about going back. Professionals can’t get back before 6 months. A few professionals tried to go back after 3-4 months and all re-injured themselves.
Linda
Hi,
My daughter just has ACL surgery on her right knee. We have heard that Red Light Therapy will help with the healing and swelling. What are your thoughts on this?
No quality science to support it … as far as I know.
Kayley
Hello,
I completely tore my ACL and got Lateral and Medial Meniscus tears on both sides from soccer. I got ACL/Meniscus reconstruction surgery about two and a half months ago and I have no pain. Do you think it’s possible for me to start playing soccer again or at least start running? Also, when I return to playing soccer, I heard that I might need a special knee brace to place soccer. Is that true?
no way… no one is ready in 2-3 months. Your risk of re-injury would be very high if you attempted to return to soccer now.
L. Pereira
Hello Dr. Luks.
My daughter at 13 tore her left acl and meniscus (did not require stitches) and 13 months later (at 14) tore her right , however this time her meniscus required stitches–crutches for 6 weeks. What are my daughter’s chances of continuing to play with both acl’s and meniscus having torn? She loves the sport and determined to play again–knowing full well that they can tear again. I am concerned about her long term physical damage to her knees if she continues to play. She is an excellent athlete but what are the stats on girls at her age with both acl /men. tears playing collegiately or beyond. I do not want to discourage her but instead mentally and emotionally prepare her with what the studies show. I would still let her play and anything we get past that would be something to celebrate.
You are asking all the right questions… The statistics show that she is at a high risk for re-injury (18-25%). If she is going to continue to play then a professionally supervised ACL prevention program is a must. But … this is a convo that many sports docs are discussing at our advanced meetings… It might be wise to consider alternative sports with less risk of ACL injury.
Javier Dorticos
Doc i have the surgery coming up and i wanted to ask. i’m usually very nervous for any of this type of stuff and my hear rate gets elevated an so does my BP. Once i go in to do the surgery what happens if i go in, in a very nervous state. What are some of the recommendation you can give me to try and relax before i go in. I’m very excite to do the surgery and get back out there but i’am very nervous about it.
Gene
Hello Dr. Luks,
In regards to the subject of using a post op knee brace or not : I understand there are recent reports and studies stating there appears to be no significant benefit in using a brace post op and there’s a tendency by many surgeons to not prescribe one.
However with a functional hinged brace being able to lock an injured knee at a certain position to prevent knee shifting/sliding, my question is wouldn’t that help in preventing the graft if not from tearing but from stretching/straining? Or is the amount of force that would need to be applied to traumatize a new graft will need to be significant enough where a brace wouldn’t be able to adequately protect?
Thank you for your time,
We choose not to brace because 1. the reconstruction is strong and can handle a fair amount of activity without the need for a brace. The ACL is stressed with cutting and twisting and pivoting– not with walking, cycling etc. A brace is not very effective at controlling rotation. No studies show that use of a brace post op improves the result.
2. the brace can become an emotional crutch… and the athlete can at times find it hard to get out of the brace. It provides a false sense of security. And may in the end delay the rehab if the athlete relies too much on the brace and the “I am injured and I need a brace” mindset.
Javier Dorticos
Thanks for answering doc that’s deft some good news to hear. Right now my current doctor is DR. Kalbac who is currently working with the mens national team and i found it kind of odd he mention a cadaveric procedure. i’m really and excite to do the surgery as soon as possible but i’m also scare to death. All this getting a surgery type stuff just scares me to death. What are you best advises for when the day finally arrives.
Javier Dorticos
Hello Doc – I wrote to you like two month but never really got an answer. My question is i tore my acl like 4 month ago and have not been able to do surgery. I’m a 30 year old male who just came off playing semipro soccer. My soccer activities are very active and very competitive playing from 3 to 5 times a week. My question is the doctor is recommending me the cadaver procedure and is this the ideal one for my age? I’m going back once i’m giving the OK full time like if nothing ever happen.
A cadaveric ACL for a semi-pro soccer player is probably not the best graft to consider using. There are better options with a much lower failure rate
Tom
My daughter is scheduled for ACL reconstruction surgery this week and is anxious to return to her sport, lacrosse. She is a division 1 level college recruit and we want to ensure that she has fully recovered before allowing her to return to play at a competitive level. What is a reasonable time frame for her to return safely and at a pre-injury level? Can you recommend a high performance sports brace?
Very few of us use braces… they do not protect against reinjury,can cause weakness and often simply become an emotional crutch.
Return to sports is determined by the ATC and therapist as well as her surgeon when she completes the program (including neuromuscular training). Average is 7-12 months…
Paul
Hi Doctor Luks,
I tend to have intermittent issues with pain and swelling in my knees, especially after heavy athletic activity. I had ACL reconstruction and Medial Meniscus repair in the Winter of 2009 on my left knee and the same done on my right knee in the winter of 2012. A lot of the time the swelling comes with no pain. Is this normal? Do I need to go back to a physical therapist to try to further strengthen my knee?
Thanks,
Paul
Swelling isn’t necessarily normal … I would pay your doc a visit and see what they think.
Didi
I have an athlete that tore her ACL. She is cleared for sports (no pain, no soreness). The problem is that she limps when running. How do I assist her in running and not limping. I am scare that she injures the other foot.
She should not be cleared for sports. She will be at very high risk for a recurrent tear. She needs to be evaluated to find out why she limps and that needs to be treated prior to considering a return to sports
Sabrina
I have had three ACL reconstruction surgeries as well as three meniscus tears from soccer. I play competitive soccer and I was offered a position on a D1 women’s team. I was wondering if I should quit the sport or continue trying to play. If I am not able to continue playing soocer I want to take up Spartan Race training or crossfit when I’ve healed from this third surgery. However will my knee be too weak to do such activity?
Unfortunately in your situation, and to protect your knee for the long term, staying away from contact sports and activities requiring a lot of turning, pivoting and twisting would be advisable.
raghu
Hi sir, can u plz tell clarify my doubts about acl…i got acl reconstruction surgery few years back and i did all the prescribed exercises for strengthening the leg..but while playing cricket or fast running r jumping then am loosing the stability of the leg and 2 days i an having heavy pain.. can u pl suggest me can i play or not??
You should consider seeing a sports medicine doctor for an examination
Nick
Dr. Luks,
I had my acl surgery on feb 2015. I’ve been through rehad and am still rehabbing on my own. I stopped running a couple weeks ago due to my other knee bothering me. I work out my acl knee w the rehab that the doc gave me twice a week and had been running 3 days a week around a mile a day. It’s a sharp pain when I raise my other knee so I stopped running all together but have been riding the bike for a mile now 3 times a week. My other knee has not been bothering me as much now that I switched it up. I work my other knee out limited w the acl workout that I do with my acl knee now. Is this just a case of runners/ jumpers knee???? Or I was scared maybe its an mcl tear in my other knee???? Any thoughts are greatly appreciated. Thanks.
Rebecca
Dr. Luks,
First, could you tell me what a Level I sport is? Is gymnastics considered a Level I sport? My daughter had ACL/Meniscus surgery in the beginning of May 2015. She’s been doing PT, adding new drills in. She has stayed at gym, mostly just conditioning. She would like to start introducing some light gymnastics. For example, light tumbing on a tumble track. Her surgeon said she cannot because the nerve for the graft isn’t formed so there isn’t a strong connection between the knee and the brain. Is this true? And I’m having a hard time understanding why she can do full on sprints up and down the stair well at PT but cannot do very basic tumbling on a tumble track. (Long trampoline) What is the difference?
Hmm… the nerves that were once in our ACL have not been shown to regrow.
There are fairly decent return to sports criteria that an athletic trainer or physical therapist can run through with you. If your daughter meets the criteria (it still might be a little early) then you can consider a return. BUT… The risk of re-rupture is very high if the leg isn’t properly trained and rehabilitated. So do not rush a return if the criteria are not met. And BTW… strength is only one small consideration. Balance, agility, mechanics, etc have a lot more to do with successfully returning.
Class I sports have a high % of cutting, turning, pivoting and twisting. I would consider Gymnastics a Class I activity.
Indi
Hi, I tore my first ACL in sep 2012 returned to soccer 2014 and tore my acl again this past march. First surgery was a hamstring graft and the second was the patella graft. So far this graft feels stronger than my first graft. Often when I cross my knees when I’m sitting it feels like my knee cap falls and my knee clicks. Its not painful but extremely uncomfortable when it happens. Every time I squat and lift, my knee grinds and occasionally hurts. Soccer season is starting up around December, and basically I’m wondering if it could be a possibility for me to have a successful season in a 7 month recovery. I know professional athletes can return back to their sport in 6 months after a patella graft.
Im now 18 and a really good soccer player. Is it worth it returning to my sport within 7 months recovery?
You need to work with a very experienced trainer or therapist. There are many tests needed to see if you are ready. Strength is only one small consideration.
Renny
Dear Dr Luks,
I’ve had my ACL recon in December Last year. During my last visit at 7 months I was given full clearance by my surgeon , then I also mentioned that I have severe pain in my knee when running or on busy days. My surgeon mentioned that it is normal and the pain will go ensure to tape the knee well while you jog. Its been over 6 weeks since then and I’m not able to run continuously even for 5 mins without pain, the level of pain is 8/10, and it becomes very difficult to continue running. I have since them mentioned to my PT , but he also says that this pain will go. Deep within me I have this fright that this could be something that needs attention as I had a similar operation to my other knee and I never faced such a problem at 8 months.
I understand that only a MRI would be able to give a clear picture of the situation , however I also wanted to know if these symptoms are common, I have regained full quad strength , I can also step-up and down for over 10 mins without any pain. I can squat with no pain 150 kg, Leg press 120kg , Lunges 50kg .. all of the activities in the gym with no pain /discomfort, its only when it comes to running I suffer.
Can you please give me your advise/opinion on this , any help will be highly appreciated.
Regards, Renny
Hi Renny …
Eight months out from an ACL reconstruction these complaints are not common. Perhaps you should consider a second opinion.
Good Luck
Lisa
Hello Dr. Luks,
My 17 year old has had two ACL surgeries on his right now within 4 years. The first surgery was in November of 2011 and the second was in April of 2014. The first injury in 2011 showed that his ACL was completely torn. Surgery was done with a cadaver ligament and a year later was cleared to play again. The second injury was a torn ACL and partial meniscus tear. Again surgery was done with a cadaver ligament and there was ample blood flow to repair the meniscus. My son is starting preseason now with his high school soccer team and is feeling soreness in his knee. He stated that it feels more like his meniscus that is causing the soreness. I am scared to death that a third injury to his right knee will be devastating. I don’t know if he or I could handle it. Would you recommend that he continue playing just have him pursue more strength training, etc? Or should he just eliminate playing all together?
Thanks so much!
Such a difficult situation for you and your son… I’m sorry. Only a good exam and perhaps an MRI can tell what’ going on. I would also consider another opinion. Most sports docs would not recommend a cadaveric graft in a high school athlete. They tend to stretch and re-rupture far too often.
Nadia
My 17 year old son tore his acl and has a small meniscus tear as well as a cyst in the medial femoral. He has been offered 2 college soccer positions div 3 for August 2016.
He will have all surgery 7/24/15 and his dr wants to use his hamstring. Do you recommend patella or hamstring for 17 year old players that want to return And play collegiate soccer?
A hamstring graft might cause weakness… the gold standard is still the patella graft.