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What to Expect Following an ACL Tear

Friday, December 13, 2019

By: Chris Miller PT, DPT, CSCS

So, you injured your knee and set up an appointment with an orthopedist. They examined your knee and told you that you need an MRI to determine if your ACL or any other structures in your knee had been torn. You scheduled the MRI and sat in the machine as still as possible. A few days following the MRI you returned to the orthopedist who confirmed that indeed your ACL was torn.

At this point most people have about 1,000 questions running through their mind, too many to even begin to ask. Do I need to have surgery? How long is the recovery? Will my knee ever be the same? When will I be able to walk normally? Will I be able to return to my favorite activities again? The whole thing can seem very overwhelming. 

Going forward I am going to explain a little bit about what the process looks like, about how long it will take, and hopefully answer some of these questions for you. Having been through the process myself when I tore my ACL about 10 years ago, and treated many people with ACL tears since, hopefully I can provide some insight to you and remove some of the unknown. Of course, this process will vary from person to person, and no two people respond the same, but this will give you a rough idea of what to expect going forward. 

Following an ACL tear there are two options to attempt to return to your normal activities, surgical and non-surgical. The surgical approach is most commonly chosen if you want to return to running, cutting or jumping activities, while the non-surgical approach can be taken for some people who do not wish to perform these types of tasks. We are going to focus on the surgical approach.

If you opt for the surgical approach your surgeon may send you to PT prior to surgery. If you are at all limited in your range of motion or have a significant amount of swelling then that will need to be addressed before the surgical reconstruction. This stage will focus on bending and straightening your knee, as well as making sure your muscles are strong before going through surgery. Not everyone will go through this "prehab" stage, but many will.

Following surgery, you will be referred to a physical therapist. The timeline for beginning your rehab will vary depending on the surgeon. Some surgeons will send you to the PT the day after surgery, and some will wait, and have you start a few days or weeks following surgery. Your first day with the physical therapist will be spent examining your knee and creating your home exercise routine. It is extremely important that you perform your home exercises diligently in order to ensure a proper recovery. You will also be given a brace that will be locked keeping your knee straight, and crutches for getting around.

The first several weeks of physical therapy will be spent focusing on stretching and range of motion. It is common to have some stiffness following surgery and it is important to ensure it moves properly. You will also spend time ensuring your quadricep (the group of muscles in the front of your thigh) is firing properly and trying to limit atrophy or weakening of that muscle. At around two weeks you will have a follow up with your surgeon.

After those first several weeks your program will begin to include more strengthening. You will be doing exercises like mini squats, bridges and leg raises to strengthen your knee and hip muscles while avoiding placing too much stress on the graft as it is healing. You will begin weaning off the crutches sometime around 4 weeks after surgery, though this can vary, especially if you also had a meniscal repair or some other injury in addition to the ACL reconstruction. Your physical therapist will also gradually unlock your brace to allow more motion at your knee as you are walking so that by around 6 weeks after surgery you will no longer need the brace. 

By about 8 weeks after surgery you should have full range of motion and you should be walking normally without crutches or the brace. The focus at this stage continues to be improving the strength of the muscles around your knee. Beginning around week 10 you will begin to focus more on exercises in standing such as lunges, squats, leg presses and step ups. Also around 10-12 weeks you will begin to perform some light plyometric activities in rehab to begin to prepare you for running and more impact activities. Bear in mind this can take much longer in some cases depending on your progress to this point and any other additional injuries you may have had.

By around 14 weeks after surgery the goal will be to perform a return to run test to ensure you are ready to begin running. If you pass you will be cleared to slowly begin jogging. Some people will no longer need to continue to come in for therapy shortly after this stage. If your only goal following surgery is to be able to run and you do not wish to return to sports, you may just need a few more weeks to ensure a proper recovery.

If you are looking to return to pivoting, cutting or contact sports your physical therapist will begin introducing some agility drills and you will continue to work on your strength and balance. The goals for this phase are to improve your strength, endurance, balance and stability to prepare you for a full return to sports. Your therapist will want to ensure that your surgical side is just as strong and functions just as well as the non-surgical side before you return to your full activity. 

Over the next several months your therapy sessions will include more challenging exercises and more jumping, cutting, and landing exercises. The goal is to have you prepared to return to sports at about 6 months post-op. Some people do need more time than this and some are prepared within this time frame. When your therapist and surgeon feel that you are ready, they will have you perform a return to sport test to ensure that you can be cleared. When you pass the return to sport test you can begin to return to sports. Generally, it is recommended that you slowly progress in your return until you are participating fully. Your therapist and surgeon will discuss how best to return to your sport safely.

Our goal is to ensure everyone has a successful outcome and return to the activities they love. This is a general outline of how we approach getting people to the level of function they desire and will vary from person to person based on many factors. Hopefully this gives you an idea of what the process will look like and answers some of your questions. As always, listen to your therapist and surgeon as they will best be able to guide you through your specific injury and recovery!

About the author: Chris Miller PT, DPT, CSCS is a staff physical therapist in the Shelton location for Connecticut Orthopaedics. He graduated with his doctorate from Quinnipiac University. Chris blends his background as a strength and conditioning coach and physical therapist to treat a variety of orthopedic injuries to get patients back to the activities they love.


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