ACL reconstruction is one of the more common knee surgeries being performed in orthopedic medicine today. ACL tears are a common sports injury and can be a career-ending injury in many athletes or weekend warriors. Most ACL injuries occur via a planting and twisting mechanism, such as during a sudden change of direction in soccer or basketball. The knee will often make a popping sound followed immediately by pain and a “giving way” or unstable feeling.
Most patients with ACL tear present at the doctor’s or physiotherapist’s clinic with the help of crutches and are recommended to consult an orthopedic surgeon. Many patients are now opting to avoid surgery and instead undertake a rehabilitation program and bracing in hopes of stabilizing the knee and many have good outcomes. Most patients however will go ahead with surgery followed by 6 to 12 months of rehab to ensure a stable knee.
The surgery for ACL reconstruction is generally fairly successful. Some research is showing that almost half of ACL repairs are failing within the first year, but it is suggested that failures are most likely related to poor compliance of the patient post-operatively.
The surgery that is most commonly done is a hamstring graft which uses a harvested portion of the patient’s hamstring tendon which is then anchored inside the knee joint proper to mimic the action of an intact ACL. It takes up to 6 months for the graft to mature and reach full strength. Hamstring rehabilitation is important after this type of reconstruction, as the hamstring muscles perform a similar action to the ACL during activity in that they help to decelerate the forward motion of the tibia on the femur.
After surgery you will be able to bear weight as tolerated on the operated knee, most patients are a week or so before they are starting to put full weight on the leg. Most patients need crutches for the first week or so. Rehabilitation should be started early and is very comprehensive throughout the first 6 months to a year post-operatively. Goals are to regain full knee motion early while controlling the amount of inflammation and swelling in the knee. Gradually the patient will build strength and sport-specific activities can usually start within 20-24 weeks after surgery. Many patients will still require the use of a brace for certain high-demand activities, but not all.
Good luck and happy rehab!
