It’s Time For ACL Repair

An anterior cruciate ligament (ACL) injury is the most significant, long-term knee injury, especially for athletes. This is a rupture of the ACL, a strong ligament in the knee that connects the tibia and fibula. The ACL is vital to movement, especially knee and leg stability. ACL injuries are common, with many requiring surgery. For athletes in particular, ACL tears were once considered career-ending, and surgery was complex. With today’s surgical advancements, however, ACL repair is straightforward. Many individuals return to normal activities, but this does not mean the process is easy. If the goal is to return to peak performance, there are many steps, especially after surgery. Knowing what to expect at each stage helps ACL patients navigate what could be a long journey.

What to expect before surgery

Someone with a suspected ACL injury should see a medical professional immediately after securing the knee. Surgery does not happen on the same day as the injury. A doctor or specialist will perform a series of physical tests, along with imaging, to confirm the extent of the injury. Imaging also helps to assess if nearby structures, like the meniscus, are affected. This helps the medical team determine the best surgical approach based on age, activity level, and long-term goals. Next, the patient will begin pre-operative physical therapy to reduce swelling, improve range of motion (ROM), and prepare for surgery. The patient will have a set date for surgery as well as instructions to prepare for the procedure.

What happens during ACL repair?

Most ACL repairs are performed in outpatient settings with a procedure that can take up to 2 hours. Outpatient surgery means the surgeon will use arthroscopy, performing the procedure through 2-3 buttonhole incisions. During surgery, the scope is inserted into a single incision. Another incision allows the surgeon to remove the damaged ligament. A graft is used to replace the damaged ligament, often harvested from a donor, the patient’s hamstring, or the patellar tendon. Bone tunnels are drilled in the tibia and femur to anchor the new ligament using screws and other fixation devices. After testing the ligament, the surgeon closes the incisions. The patient then undergoes a short recovery before leaving the hospital or surgical center.

Your recovery starts now

After surgery, the knee will be bandaged and immobilized, with recovery starting almost immediately. The first 2 weeks consist of managing swelling and bruising. Ice, elevation, and pain medication are vital during this time. Weight bearing with crutches is recommended for short distances. Weeks 2-6 indicate the early stages of recovery. PT focuses on achieving full extension and reducing swelling. Crutch use generally reduces. Closer to week 6, the focus shifts to strengthening the surrounding muscles. From months 3-6, recovery gradually increases in intensity, with running and agility slowly introduced. Most patients can return to desk jobs from month 2 and other physical activities from month 3. Athletes, however, need extensive treatment to return to full fitness. This process can take up to 12 months.

Long-term outlook for ACL repair

ACL injuries are not the end of physical activities or sports. The injury can be repaired with advanced surgical techniques, so prepare for each stage of treatment. Physical therapy compliance is arguably the most important factor, especially for those who hope to return to sport. Patients are encouraged to follow all recovery instructions and be patient. Recovery takes time and can even have a psychological effect on patients. Get support from friends and family while maintaining good communication with the doctor and PT team. The success rate for ACL reconstruction is high, and most people return to activities with proper rehabilitation.