After around 4 months, more strenuous exercise is introduced, depending on the individual progress of the patient. Sports-specific drills may also be introduced. I usually allow training with your team at around months, but no contact sport.
Full return to sport begins at months, but contingent on adequate muscle strength, control, and fitness. In situations where allograft has been used, or in a revision situation, I advise much slower progression.
Choosing the right time to return to sport involves many factors, including graft type, return of strength, and return of muscle control. Ultimately it can involve weighing up the risks of returning earlier, which many elite athletes may feel is worthwhile. Successful incorporation of the graft and ACL recovery is a biological process, much like the healing of a cut on the skin, over which the patient and the surgeon have limited ability to hasten.
How long does it take to recover after ACL reconstruction? Animal and human studies have demonstrated several phases of the healing process: Early graft healing phase with death of graft cells, and no vessels invading the graft tissue. The graft cells die, but there is no loss of strength initially. So that being said your ACL is a very important ligament in your knee with a very big job! The most common way to injury your ACL is with a load on your leg and twisting. It is common in many sports including rugby, netball, basketball, and football amongst others.
In most cases, your knee swells up immediately and you have a significant limitation of movement. When you do put a load on your leg you have a feeling like it is going to give way unless you a very careful. Due to the magnitude of the injury, there is often damage to the inside ligament of your knee MCL and the cartilage on the inside meniscus.
Sometimes you get some bone bruising as the two bones smack into each other. This is all confirmed with an MRI scan. During an ACL reconstruction, the surgeon must remove the torn pieces of your original and ruptured ACL and effectively have to build you a new one by taking a graft from either your hamstring or patellar tendon. The graft is then inserted into tunnels that have been drilled into the thigh and shin bones and attached with hardware.
This is a pretty big surgery! Then will continue to travel down the graft toward the center of the graft in the knee over the entire first year. Did you hear me say that? There is no healing of the graft at all until 3 months post op? That is why we consider patients at the highest risk of graft failure from weeks post op. During this time their graft is at its weakest and their postoperative pain has worn off.
This is the time period when I usually see kids jump off diving boards, attempt gym class, and pickup basketball games all against orders.
It is also when we see the most re-tears of ACL grafts, which should now come as no surprise. I know by now I may have you a bit freaked out by the whole notion of rehabilitating an ACL.
Do not worry there is a lot of science on our side. First, we have a list of the best physical therapists in town; many we have worked closely with for years. Ask us for a recommendation before you rehab! Next, we use a testing based program to make sure you are ready to advance to the next step of the protocol. For instance not all patients are at the same step at the same time, it would be foolish to think they would all achieve goals at the same rate. We perform a test called a Biodex around 4 months post op to check the strength of the hamstrings and quadriceps in their operative verse nonoperative leg.
If their strength is similar they may begin jogging and light plyometric activity, if not they continue strengthening and try again in a few weeks.
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