ACL surgery is very common in the US, with approximately 100,000 surgeries performed every year. Currently I perform about 125 of these surgeries a year, and I’ve seen in my practice, like most sports medicine surgeons, that overall the outcomes are outstanding. It certainly helps that this is an injury that occurs in athletes, so it makes sense that these athletic individuals do well after a difficult surgery. I have seen patients breeze right through the surgery and rehab, and I’ve also seen some who really struggle before finally doing well. One comment I often hear from athletes just after surgery or early in the rehab is how difficult the whole process is compared to what they expected. For that reason, I thought it would be good to briefly discuss the surgery and rehab.

What to expect from ACL surgery

ACL surgery is an outpatient surgery, and it only takes 60 to 90 minutes, but it is a big surgery. It may be done through the scope using only very small incisions, but a lot of work is done in the knee. As I’ve discussed in another post, the surgery involves using tissue either from the patient’s knee or from a cadaver’s knee to make a new ligament. And even though the surgery utilizes fairly small incisions, it’s still painful. The tissue used to make a new ligament is passed through tunnels drilled in bone, so it makes sense that there is a lot of pain after the surgery. Plus, the knee is fairly swollen after the surgery due bleeding from the tunnels and from the fluid run through the knee in order for the surgeon to see through the scope. Having said that, most athletes say that the worst of the surgical pain is gone in the first 2 to 3 days. Tips for better outcomes after surgery.

What to expect from rehab from ACL surgery

Most patients tell me that the hardest part of the rehab is the first 4 to 6 weeks. I usually limit the amount of weight the athlete can put on his or her knee in the first few weeks, and I ask him or her to wear a brace for 2 to 4 weeks to protect the knee. I start the patient in physical therapy almost immediately after surgery, but patients are very surprised at how difficult therapy is in these first few days and weeks. The focus is to regain full range of motion and early quadriceps and hamstring strength. Patients often get frustrated due to their limited ability to walk and the boring nature of exercises such as straight leg raises and stretching exercises to straighten and bend the knee.

Also read:
ACL injuries: Rehab and return to sports
When can you return to sports after ACL surgery?

After the first few weeks, though, therapy gets much more aggressive, and honestly, more fun. As the knee motion and strength improve, therapists will allow the patient more functional activity, including different forms of cardiovascular exercise. In the later phases of the rehabilitation, the athlete will be allowed to do more functional strengthening and work on plyometrics and agility drills. Sport-specific training over the last few weeks can complete the process and optimize the athlete’s return to sports.

If you are preparing to undergo ACL surgery, what I think is important to remember is that this is a long process. Return to sports is often prohibited for 5 to 6 months. This long amount of time really has less to do with how hard the athlete works but more to do with how long it takes for the tissue used to make a new ACL to actually be incorporated into the knee. Certainly how hard the athlete works does play a role. I do tell athletes that the harder they work on the rehab, not only with the physical therapist but also on their own, the better their outcome will be. They will be less likely to reinjure it as well. In my experience, athletes who work very hard on their rehab often feel that the knee is just as strong as it was before and often feels stronger than their uninvolved knee. As I’ve said in many posts on this blog, communication with your surgeon and physical therapist and hard work on your own are critical to having the best possible outcome.

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