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:
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.
Howard J. Luks, MD
Definitely worth being evaluated. A good sports medicine doctor should examine that knee to be sure that the ACL is functioning properly.
Good Luck
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?
Howard J. Luks, MD
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?
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
Howard J. Luks, MD
Perhaps your new ACL is not functioning well. I would see your doctor again. Or possibly a second opinion.
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.
Howard J. Luks, MD
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.
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?
Howard J. Luks, MD
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.