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:
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 ?
Howard J. Luks, MD
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
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?
Howard J. Luks, MD
Without examining her I can’t really say what’s going on…
Good luck though!
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?
Howard J. Luks, MD
Could be both ??
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?
Howard J. Luks, MD
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!
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.
Howard J. Luks, MD
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.