Approaching ACL reconstruction surgery can be intimidating and confusing. Should you get a cadaver graft or use your own tissue? Should you do any rehab prior to surgery? Should you even have the surgery? The answers are different for each individual but we, along with your surgeon, can help provide you with the information needed to make the most informed decision.
Come in for a free preoperative visit and we can discuss the particulars of your case. We can also get you scheduled for your first postoperative session, usually 7-10 days after surgery. Many patients also would like to discuss costs and insurance coverage at this time. We can contact your insurance company for you and determine your specific benefits, tailoring your care to maximize your financial situation as well.
Immediately after surgery
After the surgery, there are simple things everyone should do like rest, ice, and elevation. Your surgeon will provide you with other restrictions specific to your particular surgery. Most will provide you with some kind of knee brace or immobilizer to make bearing weight go a little smoother. You can also expect to be on crutches from 2-4 weeks. The specifics vary and is dependent on the surgeon and the exact procedure that was performed. Other procedures commonly performed during ACL reconstruction such as meniscus repair and microfracture can cause delays early in the rehab.
Your first physical therapy visit is usually scheduled for 7-10 days after surgery. We will assess your swelling, range of motion, strength, and pain management. We will also make any adjustments necessary for your brace and/or crutches. At this point, we set up a personalized plan of care to address the issues unique to your case and give you some homework. We will usually have you return a little later in the week to see how things have changed since the first visit.
The initial goals are to get your knee range of motion back and encourage your quadriceps to begin engaging. Quadriceps function will be a continuing concern throughout your rehabilitation.
During this phase of the rehab, much is dependent on how well your knee is calming down and you are meeting these initial goals. If everything is looking good and progressing well, you may not need to come in for very many physical therapy visits until you enter the next phase.
As the new graft is healing into the bone tunnels, we focus on building strength throughout the lower body while protecting the graft. As long as the knee stays “quiet” (minimal pain/swelling) we can begin introducing exercises such as squatting motions and progressing towards higher intensity activities like deadlifts.
During this phase we focus on establishing good lifting habits to get the most out of all of your workouts in the future. There is a lot of misinformation out there about what is most important regarding movement, much based on opinion. We will help you understand the details and where you should focus most of your efforts.
Building Foundational Strength and Power
Once we get the blessing from your surgeon that your graft has integrated well (usually around 12 weeks after surgery depending on the type of graft) we begin with more aggressive strength and power training. We implement classic strength and conditioning principles while integrating modern assessment technologies.
Researchers have identified that poor quadriceps performance correlates with poor return to play and a higher likelihood of sustaining a 2nd ACL tear. Recent studies have shown that only around 30% of ACL reconstruction patients have even the most basic of quadriceps strength even 6 months out from surgery.
Many exercises like squatting movements are useful, but athletes can still perform these lifts without effectively loading their quadriceps. Our program integrates many different exercises with the goal of forcing the quadriceps to participate.
During this phase we use our isokinetic dynamometer (fancy force gauge) to assess many factors related to the performance of the quadriceps including absolute strength, rate of force development, total work output, etc. We can compare these measurements to your uninjured side as a simple comparison.
This all falls under the category of “foundational strength and power”, the strength required to perform the tasks that you want to get back to. Besides simply comparing to the uninjured side, we have different targets for each individual depending on body weight and the sport/position they play.
During this phase, some patients perform the majority of their program under our direct supervision in our gym. Others come in only once a week, once every two weeks, or even once a month just to check their progress while they do their workouts on their own.
Coordination Training and Return to Play
Once you start developing foundational strength and power, we will start assessing your coordination; how you move when you are simulating the demands of your sport. Some believe that there is a “perfect” way to move, but there is much variation amongst athletes when it comes to movement. We explore what are the best ways (plural) for YOU to move.
We encourage you to participate in as much free movement practice in a safe environment for your body to relearn the best way to move. Our goal is to get your muscles to handle the lion’s share of the loads that enter into your legs when jumping, landing, and cutting.
During this phase we will test your knee and overall function and advise you on your risk profile to make sure that you return to your sport or activity with the lowest chance of a second injury as possible.
How long will it take?
Athletes who undergo ACL reconstruction return to play around 9 months ON AVERAGE. Every individual is different. Some get back sooner but researchers have recently pointed out that some athletes can take as long as 2 years for full return. This has nothing to do with the plan of care of the provider or the work ethic of the athlete.
Anyone who promises that they can get you back by a definitive date before 9 months is either lying or misinformed. In such situations, the push for a fast return creates a high risk of overlooking serious deficits and sustaining a second ACL injury (usually to the other knee).
We promise to get you back as fast as possible, BUT NO FASTER.
After Your Return to Play
Even after you have returned to play, we are happy to stay involved if you chose. Some of our athletes will come back in before the beginning of the next season to make sure that their knee hasn’t learned any “bad habits” (not likely) during the offseason. We can put together a new plan of action for anything that may have changed so you can lower your risk profile again.
Of course if anything comes up in the future, we are always just a phone call or email away. Just let us know!