ACL surgery: Answers to questions you might have about ACL reconstruction

An ACL injury is a devastating injury. You might miss the rest of your sports season. You could need ACL surgery. You might face months of rehab. It might take a year or more to return to play.

You might have a lot of questions about your ACL tear. These are some of the most common questions patients have.

I tore my ACL. Do I need surgery?

The anterior cruciate ligament (ACL) is a ligament in the center of the knee. It provides front-to-back and rotational stability. A torn ACL does not usually heal on its own. A patient can usually regain full knee motion and strength. However, she might struggle with an unstable knee. An older or less active patient might do well without surgery. A more active person or athlete who plays sports that requires cutting or pivoting motions often needs surgery. Surgery can restore knee stability and allow her to play normally.

ACL reconstruction surgery involves making a new ligament instead of repairing the ends of the torn ligament. The tissue used to make a new ligament can come from the patient (autograft) or from a donor (allograft). The patient’s preference, activity level, and age can influence the graft choice. The most popular autografts are part of the patient’s patellar tendon or one or two of her hamstring tendons. Each autograft and allograft has its own risks and benefits.

Can I have ACL surgery right away? Or should I wait a few weeks after the injury?

After an ACL tear, a patient’s knee often becomes swollen and stiff. When surgery is performed while the knee is swollen or stiff, it is more likely to become stiff after surgery. Waiting two or three weeks to decrease swelling and improve motion can improve outcomes.

Should I do physical therapy before surgery?

An exercise program before surgery might help restore muscle strength and lower extremity function after surgery. A physical therapist can help a patient decrease knee swelling and improve knee motion before surgery.

Also read:
Athletes who haven’t returned to sports 1 year after ACL surgery
Rehabilitation factors that might influence outcomes from ACL surgery

Physical therapist working on knee motion after injury

What can I do after ACL reconstruction?

Surgeons often have different restrictions after ACL surgery. The presence of other injuries, like meniscus tears, might alter the restrictions. Some surgeons allow full weightbearing. Others surgeons don’t let the patient put weight on the leg. Some require a patient to wear a knee brace. Others don’t. The patient works with a physical therapist for months to regain knee motion and strength of the leg muscles. She can usually start jogging around 12 weeks after surgery. She can often start more sports activities after that.

When can I return to sports after ACL surgery?

The length of time after surgery by itself does not determine return to play. It can take a graft 6 months or more to mature. If a patient tries to play sports too soon, the graft might fail. Working with a physical therapist can help in many ways. You can regain muscle strength, balance, and coordination with athletic movements. That work is critical to return to the same level of performance. It can also decrease the risk of reinjury. The recovery and return to sports process varies from patient to patient. It can take 6 to 12 months or more to return to sports at the pre-injury level.

Will my ACL surgery work?

ACL reconstruction is fairly successful. About 5% of patients tear the graft or tear the ACL in the opposite knee in the first year. Return to play is another measure of success. Return to play rates are good but not great. Even a year after surgery, up to half of athletes are not playing at the same level as before the injury. If you work hard on your recovery, you can have a good outcome.

Also read:
When is an athlete ready for sports after ACL surgery?
Ask Dr. Geier – When can you return to sports after ACL surgery?

If you are preparing to undergo surgery for an ACL tear, consider asking your surgeon these and any other questions you might have before the procedure.

Knee brace for ACL surgery