Introduction

So you to ACL and you want to know when you can get back to play. Let’s break this down.

What Happens When You Tear Your ACL

So what happens when you tear ACL? Well, the ACL is a ligament in your knee that connects the femur bone to the tibia bone and it prevents rotation and translation, twisting and bending in certain planes. Most of the time you hear a pop and then it swells up and the knee just doesn’t feel right. You lose range of motion and there’s significant pain.

Common Causes of ACL Tears

What are some common causes of ACL tears? Well, the most common is a non-cont injury. That means you haven’t been pushed or nobody’s knocked into your knee. It can be an awkward land, a twist, and that’s the most common. It can also tear with direct contact, but that is not as common as the non-cont cause.

Surgical and Non-Surgical Options

What are the surgical and non-surgical options for ACL recovery? Well, non-surgical consists of rehabilitation and bracing. Typically, in the office setting, it’s a lower demand patient that does not want to return to twisting, high demand activities. Maybe lower demand, more computer oriented or something like that.

In terms of reconstruction, this is typically for people that want to get back to sports, twisting activity, jumping, and running. A full reconstruction recovery typically takes longer than the rehabilitation only portion of treatment.

What are surgical and non-surgical options for a torn ACL? Surgical options are full reconstruction, typically using your own tissue, sometimes a donor tendon. Non-surgical options are bracing, physical therapy, and range of motion activities.

Why Athletes Usually Need Reconstruction

Why do athletes require reconstruction most of the time? Well, typically because the demand on the knee, the ACL prevents that rotation and translation in certain planes of movement. And if an athlete puts demands on their knee, the knee will be at risk if they don’t have the ACL. It’s important that the ACL functions so when that patient lands or the athlete lands and twists, it doesn’t allow that knee to buckle and cause further injury.

ACL Reconstruction Recovery Timeline

What does the entire rehab timeline look like for an ACL reconstruction? It varies per patient. Typically, it’s 9 to 12 months, but it depends on the patient’s strength, mobility, core muscle strength, and also the feedback from the physical therapist. The surgeon performs the surgery and guides the patient on recovery. But the physical therapist also gives feedback to the surgeon and the patient, often times putting the patient through tests, mobility, single leg hop, plyometric activity. It’s not always cut and dry, but the general range is 9 to 12 months.

Return-to-Play Expectations

What’s the real answer when it comes to return to play? Well, 90% of patients return to play. That is the book answer, the academic answer. If you had your ACL done in New Jersey or California, you’re looking at about a 90% success rate of getting back on the field. But it does depend on the health of the patient. Before their injury, were they in shape or not in shape? After, were they compliant with physical therapy? And how do they compare to the other knee? Are they as strong? Are they 80% as strong? And have they been put through the appropriate rehab and recovery so that they can return at the appropriate timeline.

Phases of Rehabilitation

What does the rehab look like? Well, it’s in phases and typically the first phase you’re dealing with swelling, pain, some bruising and the physical therapist will assist with range of motion, elevation, and home exercises to help you get the swelling out. So, restoration of motion, get the swelling out is the typical goal for the first few weeks.

The next phase is gentle strengthening and controlled exercises. The ACL at about 6 weeks is pretty delicate, so we don’t push it too hard with heavy physical therapy. There’s modified programs called closed chain exercises that make sure the graft is protected.

After about 3 months, if all is going well, most patients can run in a straight line. Plyometrics, which are side to side activities, jumping, box jumps, things like that, more or less happen between 4 and 6 months, depending on how that knee reacts to the first 3 months.

After that there can be guided sports related activity typically not five on five or three on three but very light drilling and if the knee responds well with regard to swelling range of motion then the activity is advanced.

How Surgeons and PTs Determine Readiness

So what test do I use to determine whether an athlete is ready? Well general rule of thumb is range of motion has to be near perfect minimal swelling to no swelling full strength and no pain. In addition, feedback from the physical therapist making sure that this individual has passed all of their plyometric tests with no recurrences of instability or pain and swelling.

In addition, there’s physical exam findings like the lockman maneuver, anterior draw, making sure the graft isn’t laxed. There’s also testing the core strength and quadriceps and hamstring strength to make sure everything is okay.

The Role of Mental Readiness

Why is mental readiness as important as physical readiness? Well, in order to compete, one has to be confident in their knee. If you had nasio reconstruction, it’s traumatic injury and often times the athlete might be worried about a recurrence. Often times, you’ll see professional athletes take a year or more to come back. And it’s not just the physical part. It’s very hard to recreate the onfield activity in a therapist’s office or a doctor’s office.

Once you return to play, it really is how the knee reacts and how confident you are. I think if you have confidence and the knee shows you that it’s stable and you’re able to perform at your pre-injjury level, then you typically go on to do very well.

Athlete Success Story

One particular athlete was collegiate basketball player. She originally tore her ACL in high school at age 14 and had a reconstruction performed because of the motivation and stick tuitiveness with physical therapy. This patient went on to have a celebrated career in Newark, New Jersey, and played division one basketball at a very high level.

Choosing the Right Treatment Path

What would I tell someone if you just tore your ACL and you want to know what your options are? Well, I think age is a factor. If you’re younger, making sure you’re done growing or if you still are growing, you have to ask your surgeon if the technique has to be modified and how much growth you have left.

If you’re more high demand division one athlete, professional athlete, typically those athletes go with a bone tendon bone autograph, which is a special type of ACL reconstruction, the gold standard, many would say.

If you’re older, slightly lower demand, and you want a faster recovery, you could consider what we call alligraph, which is a donor tendon. That’s where we don’t harvest tissue from you, and we take it from a tissue bank that has the tissue verified.

It really is a discussion you have with your surgeon and hopefully he or she can give you the answer you’re looking for.

Final Thoughts

An ACL tear is a devastating injury. Many people are intimidated by it. It can take upwards of a year to recover. There’s also a mental component. My suggestion is if you have any questions about ACL tears, you want to know more about it. If you want reconstruction options, here at Modern Orthopedics of New Jersey, we can answer those questions and give you the confidence you need.

What Does ACL Tear & Reconstruction Treatment Involve?

An ACL tear is a common knee ligament injury that affects the anterior cruciate ligament. ACL tears are often caused by sports injuries but can also occur due to falls or other high-impact accidents. Mild ACL injuries may heal on their own, while more severe partial or complete tears frequently require surgical reconstruction.

Anatomy Of The ACL (Anterior Cruciate Ligament)

The anterior cruciate ligament (ACL) is a thick band of tissue that crosses the posterior cruciate ligament (PCL) inside the knee to connect the thigh bone (femur) to the shin bone (tibia) and provide stability to the joint. When the knee is forced beyond its normal limits, an ACL tear may occur.

Common Symptoms Of An ACL Tear

Common symptoms of an ACL tear include the following:

• A popping noise or sensation at the time of injury
• Pain and swelling in the knee joint
• Difficulty bearing weight on the affected knee joint
• Loss of flexibility/range of motion
• Weakness and instability in the knee joint

Diagnostic Tests For ACL Tears

An ACL tear can often be diagnosed based on the symptoms the patient describes in combination with a thorough physical examination. Diagnostic imaging tests are also frequently ordered to better visualize the affected area and check for damage to other nearby ligaments and structures. These may include X-rays, CT scans, and/or MRI.

Preparing For Treatment

If you are a candidate for surgical ACL reconstruction, it’s critical to remember that a successful recovery process involves proper preparation before surgery (pre-habilitation) as well as rehabilitation after.  The experienced team at Modern Orthopaedics of New Jersey will work closely with you to develop a personalized treatment plan that ensures you’ll go into ACL surgery with reduced swelling, strong quadriceps and hamstrings, and the ability to fully extend the injured leg.  

Results And Recovery Time

More than 125,000 ACL reconstructions are performed every year in the U.S., making it one of the most common orthopedic surgeries.  Success rates range from approximately 80-97%, depending on a wide variety of factors including the severity of the injury, the type of reconstruction performed, the age and health of the patient, and the consistency of post-surgical rehabilitation routines.  

While every case is unique, patients who have undergone an ACL reconstruction can usually expect to walk without crutches between 1-3 weeks after surgery and return to higher impact activities gradually over the course of the next 6 months.  Complete recovery after ACL reconstruction takes between 6-12 months, and sometimes longer.  

Consultation With A New Jersey-Based Orthopedic Specialist

At Modern Orthopaedics of New Jersey, our award-winning specialists are dedicated to helping you move forward on your path to complete and lasting recovery. Contact our clinic today to schedule an initial consultation for knee pain!

Frequently Asked Questions