Anterior Cruciate Ligament Surgery – Recovery and Rehabilitation
Anterior cruciate ligament (ACL) injuries can cause an afflicted knee to lose its integrity, thereby making the individual suffering with the injury feel like their knee is unstable. The tears which damage the ligament in this way most commonly occur as a result of a sudden movement (more often than not during a sporting activity).
Introduction to ACL
The anterior cruciate ligament is a ligament which connects the tibia (lower leg bone) to the femur of the upper leg. Anterior cruciate ligament surgery is most commonly required when the ligament has been involved in trauma caused by an avulsion fracture (where a fragment of bone tears away from the main mass of bone). Individuals who experience injuries of this kind should obtain anterior cruciate ligament surgery as soon as they possibly can as this will reduce discomfort and improve the long-term outlook of achieving a successful recovery considerably.
Immediately after receiving ACL surgery, a patient’s wound will be closed with stitches. If the stitches are dissolvable then they will disappear by themselves after three weeks or so. If the stitches aren’t dissolvable then they will need to be taken out the old-fashioned way i.e. by a healthcare professional.
Along with bandaging and painkillers, patients are often given a cryocuff – a waterproof bandage which contains iced water – to wear in order to help reduce swelling.
It is quite common for post-ACL surgery patients to have tender bruising, swelling and redness down the front of their shin. This is caused by the synovial fluid within the knee joint leaking down the shin. This is quite normal and typically clears up after a week or so.
Full recovery from ACL surgery can take up to a year.
Surgeons and physiotherapists will provide post-ACL surgery patients with a structured rehabilitation program. Needless to say, it is vital that afflicted individuals adhere to the program fully.
In general, the program starts with patients being given a number of exercises to carry out. These can be started in hospital after surgery and then continued at home after the patient has been discharged. In general, these early exercises will include movements to bend, straighten and raise the leg.
The following is a brief chronological outline of what a patient recovering from ACL surgery might expect when endeavoring to facilitate a successful rehabilitation
Most people recovering from ACL surgery feel swelling, stiffness and a localized pain around their knee for the first week or two. This is often alleviated by painkillers and/or a cryocuff. Along with some basic exercises, the main focus of this period is normally to keep the injured leg raised as much as possible, more often than not by putting pillows under the heel while lying in bed.
Once the pain and swelling become less pronounced, patients are generally encouraged to increase or change their exercises. In general, physiotherapists will recommend exercises that are designed to help recovering patients extend and bend their knee fully; strengthen their leg muscles; improve their balance, and begin to walk properly.
As well as specific exercises, activities which do not put excess weight on the knee – such as swimming and cycling – may also be recommended
The period between six weeks and six months is generally the time when patients gradually return to something approaching their normal level of activity. Whilst they will be encouraged to continue with activities like cycling and swimming, they will be discouraged from trying activities which involve a lot of twisting, jumping or turning. The reasoning behind this is that patients need to allow enough time for the grafted tissue inside their knee to anchor itself properly.
Six to nine months
It is often the case that normal running and twisting can be performed after six months so sports like tennis and badminton, and moderate personal workouts are normally quite permissible. Training for more rigorous sports, such as soccer, hockey and basketball, may be started during this period, although only the more ‘gentle’ aspects of the game i.e. kicking a ball, should be tried (physical tackling of any kind is strictly out of bounds). Elite level athletes excluded, the nine month mark is normally the time when individuals recovering from ACL surgery can start participating tentatively in competitive sports. However, it should be noted that the ligament will not reach its full strength until the 12 month mark so care still needs to be taken at this time. Individuals who are keen to undertake activities like skiing should wait until they reach 12 months.
After 12 months
Individuals who adhere to the program outlined by their doctor/physiotherapist should find their knee feeling strong and competent a year after ACL surgery. In general, most patients will be able to undertake full sporting activities after 12 months without feeling significant discomfort of any kind.
Returning to work
The swiftness with which a person recovering from ACL surgery can return to work depends largely on what their job involves. If their job is sedentary and involves sitting in front of a computer for most of the day then they may be able to return to work just one or two weeks after surgery. If their job involves being mobile or requires them to stand up for prolonged periods of time then six to eight weeks is likely to be a more accurate estimate.
A patient’s doctor will advise them about when they will be allowed to drive again. More often than not, driving becomes feasible whenever recovering individuals are able to comfortably put enough weight on their foot to perform an emergency. For most, this is normally around the three to four week mark.