Is return to soccer likely after ACL surgery?

We hear about ACL injuries all the time in professional sports. Robert Griffin III and Derrick Rose immediately come to mind. We don’t think of them as common soccer injuries as often – at least not in the United States. Anyone who plays soccer or has high school or college children who play, though, is surely aware of these injuries.

Knee injury in soccerAnterior cruciate ligament tears are among the most common and severe injuries of the lower extremity in soccer. A study of elite European soccer shows that a professional team can expect 0.4 ACL injuries among its players per season, or just under one player on the team going down every two years. And ACL tears are even more common among female athletes. I remember one girls’ soccer team in the Charleston area losing five players to ACL tears in one season.

Fortunately ACL reconstruction will help these players regain stable knees. In fact, in the past, orthopaedic surgeons have often quoted success rates of 90% or higher with these surgeries. So soccer players are pretty much guaranteed to return to soccer, right?

Maybe not. A study in the November 2012 issue of the American Journal of Sports Medicine examines the rates of return to play after ACL reconstruction. Specifically they look at soccer players and identify risk factors that could indicate risks for reinjury or never playing soccer after the injury at all.

Robert H Brophy, M.D. et al contacted soccer players included in the Multicenter Orthopaedic Outcomes Network (MOON) Group. This is a database of patients who have undergone ACL reconstruction by surgeons at centers across the country. They found that only 72% of soccer players returned to play soccer after ACL surgery.

This study had a number of other interesting findings as well:

    Of the athletes who do make it back to soccer, return occurred at an average of 12.2 months after surgery.

    85% of players who did return eventually got back to the same or higher level of soccer.

    Male soccer players were more likely to return to play than female athletes.

    Younger soccer players were more likely to return to play than older ones.

    12% of soccer players underwent a second ACL surgery. 75% of the second ACL procedures were performed on the athlete’s opposite, or contralateral, knee.

    Female soccer players were more likely to require a subsequent ACL surgery.

    Athletes who tore their nondominant leg’s ACL in the first injury were much more likely than those who injured their dominant leg to require ACL reconstruction of the contralateral leg in the future.

What can soccer players and fans learn from this study?

First, the finding that only 72% of soccer players make a successful return to play is lower than I think most orthopaedic surgeons and soccer players would like to see. This data does corroborate the findings of the study looking at return to sports among college football players who underwent ACL reconstruction, though.

ACL rehab
A soccer player working to regain balance, proprioception, and plyometric strength before returning to play
Also, younger and male soccer players are more likely to return to play. The ACL injuries and surgeries themselves might serve as the main barrier to return to soccer, but other factors like graduation from school, loss of desire to play, and more might play a role. Even fear of reinjury could keep athletes from returning to soccer. Regardless, the lower success among females seems surprising, at least to me.

Finally, we have discussed the importance of ACL injury prevention programs in the past. This study shows a high recurrence rate, especially in females and for injuries of the nondominant leg. Any soccer player who undergoes ACL reconstruction should consider learning and regularly performing the exercises of one of the injury prevention programs to decrease the chance of reinjury of the graft or opposite knee’s ACL.

What do you think? Do these findings surprise you? Are you a soccer player who never returned to soccer after surgery? Do you treat soccer injuries and have advice or thoughts? Share your ideas below!

Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, McCarty EC, Spindler KP. Return to Play and Future ACL Injury Risk After ACL Reconstruction in Soccer Athletes From the Multicenter Orthopaedic Outcomes Network (MOON) Group. Am J Sports Med. 2012;40:2517-22.

Walden M, Hagglund M, Magnusson H, Ekstrand J. Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc. 2011;19:11-19.

120 Responses to Is return to soccer likely after ACL surgery?

  1. Hello I just recently had surgery on my ACL last Friday. I play soccer an I want to know about this because I have so much going through my head about all this. I really do want to return to playing soccer because it is my passion but after going through this I am scared of the possibility of getting re injured I’m only 20 years old.

    • Great question! I might use it as one on my podcast soon, as it requires a longer answer than I can write here. In general, the twisting and cutting motions involved with quickly changing directions and stability required for landing makes soccer nearly impossible without a functioning ACL. Surgical reconstruction of the ACL tear is almost always required for a soccer player to return to play. Re-injury can occur, but a good surgical procedure and agressive physical therapy and functional training minimize those injuries as much as possible.

  2. Thanks for these articles! I actually just underwent my second ACL surgery (same dominant knee) in September 2012. I was told by a trainer to build more muscle on my legs in order to prevent another injury. Is that true? Any suggestions? I am a female and have every intention on going back this outdoor season.

    • Generally athletes should regain full quadriceps and hamstring strength prior to return to sports, which can help prevent injury to that knee or the opposite one. Plus it helps with sports and exercise performance. Glad the articles were helpful!

  3. So question I had ACL surgery last April 19th and it hasn’t been a year yet since then I have had a second surgery on March 21st, 2013 for fatty pad, scar tissue, and a Cyclops lesion. It will be 2 weeks tomorrow since I had the surgery and I fell going down my steps and my knee looks twice as swollen and I don’t know how badly I injuried it. Im only 17 years old and I did it during soccer and have yet to return to any type of sports. Well I want to play in the fall but I kinda nerves of reinjuring it and I don’t know what I should do. Any advice or comments would be great!

    • Natalie, thanks for the question. I really cannot give you a specific answer to your question, as I haven’t seen you as a patient or examined you or seen any radiographic studies. I would check with your surgeon. Generally if a patient regains full motion, strength, and functional ability after ACL reconstruction, he or she can return to play, even soccer. A cyclops lesion and scar tissue in the knee could hinder that ability, but I cannot say in your case.

    • Hey I have a question I have a lump on the side of my knee I been playing soccer with pain on my knee on the joint I been playing like this for almost a year I want to know what could happen to me if I don’t get it treatment soon and how are likely would I be able to go back to play if I do go to a orthopedic surgeon. get it treat

      • Without knowing what you have, I can’t say if there is a risk to leaving it alone. An orthopaedic surgeon who examines you and orders any necessary studies could better discuss the risks and benefits with you.

  4. just a few day back i had torn my ACL while playing football and the MRI shows that it is near to torn with some fiber still intact are their chance of self healing or should i opt for surgery

    • In high-grade partial ACL tears, the actual ligament fibers do not heal. If the knee is unstable, I usually recommend surgery. I cannot say specifically in your case what you should do, but your surgeon can assess the stability of your knee.

  5. I just had ACL reconstruction on March 4th of this year, I am a 15 year old female in high school and I injured my ACL during soccer. My physical therapist told me I am about a month ahead in rehab according to my protocol from my surgeon. I also play volleyball and season starts at the beginning of August, I was just wondering if you had any advice on whether I should get back into volleyball right away if I am cleared or if I shoul keep strengthening my leg for soccer season next year in March!

    • I don’t know that there is a right answer for all athletes. I think it is always a good idea for an athlete to get her knee as close as possible to 100% prior to return to sports. If there is a question of returning to early to a sport, then it can be a good idea to stay and, keep working with the physical therapist, and return either later that season or return for the next one. If one sport or season is more important than another, then I think that factor can help the decision-making process as well.

  6. Thanks for the article Dr. David Geier!

    I completely tore my ACL about 9 weeks ago (confirmed by an ACL). I’m in my early 20’s, super active (play sports like soccer, ultimate, basketball) at least 3 times a week. From early research on the topic, I was certain that I would need surgery to get back to my active lifestyle, however, currently on the waitlist, I have been doing more research and came about more findings on ACL Copers, and athletes who may not need a reconstruction to return to play at their previous level.

    I was wondering what your thoughts are on this?

    My knee appears super stable, no incidences of giving way, I can run up and down the stairs no problem (haven’t tested it on the field yet though… nor have I tried doing jumping). My muscles have atrophied dramatically the first couple weeks after injury but I’d say I’ve regained it to about 70% of my other quad. Have been going to the gym/pool everyday.

    Just recently, my physio has been noticing an “endpoint” when doing the Lachmann test… I have read about an ACL being able to scar back to the PCL and in rare occasions even completely heal after being torn.

    I have always been a fan of healing the “natural” way, but if surgery means that I will be able to play hard for another 30 years, I’ll be more than willing to take it on. However, if it’s not needed, I wouldn’t need to risk the possible complications of surgery.

    Do you have any suggestions as how I should proceed? Have you dealt with athletes who are able to perform pre-injury level without ACLr?

    Let me know when you get the chance.

    Any help would be appreciated. Thanks in advance!!

    • Unfortunately I cannot give you specific advice. If an athlete has a stable knee without surgery and does not feel the knee give way with cutting or pivoting maneuvers or landing from jumps, it might be possible to avoid surgery. In my experience, most active people do not ultimately have stable knees.

      • Shubho:

        I ruptured my ACL in my dominant leg falling from a horizontal bar…not ideal. I actually lasted 3 years without surgery. Played the odd Hockey game 6 months post injury. For 2 years focused just on my Sprinting. Then this year tried to get back into Football (Soccer). I was fine for about 4 months until a push in the back while in the air saw me land really awkwardly and tear my medial mensicus in 10 areas haha. Part of me wonders if I should of had surgery. I think it totally depends on who you are, age, what level you wish to return too. If I could change anything I would of have the surgery when I returned to my peak while my quads were perfectly strong. Would make recovery loads easier, and I wouldn’t be dealing with the mensicus injuries. Goodluck :)

  7. I am a 2o year old male I just had a injury three month ago and there were evidence of ACL tear but my doctor says that I don’t need surgery if I don’t wanna play soccer professionally but I have just get heal that I can walk slowly,Do you think that I needed a surgery? Do you think in this case I can play soccer again?

    • I think that it can be very difficult to play soccer even at a recreational level or do other activities that involve cutting or pivoting without a functional ACL. I cannot tell if you would be able to without being involved in your care, though.

  8. Hi,my daughter is 13 yrs old and tore her ACL 1 year ago as well as a latteral meniscal tear..she is 5 ft 11 inches and she also has Genuvalgum …she had surgery and completed 6 months of therapy to only have another surgery again on her meniscus as it tore more during therapy.she has just completed another 6 months of therapy and is dying to get back to is her passion and she an AMAZING goalie:)…of course i am worried sick and tryouts are this week..Her therpist and surgeon say as long as she is conditioned ,and she is, to go for it!! (her dream is to be in the Olympics and play for the USA team:))…whats the chance of her reinjuring the meniscus and acl? Thank you for your time! ~Alexis

    • I can’t really give you any specific predictions without being involved in her case. Generally we have ACL reinjury rates between 3 and 5% in the first year. Interesting to many is the fact that the rates of ACL injury in the opposite knee are actually a little higher in that first year.

  9. Hi Dr. Geier,

    Great article and tips. I’m post op about 10 weeks now on my right ACL/PCL and was wondering about the numbness on the front of the right leg that was operated on. My graft came from my hamstring. Will the numbness last pretty much forever and are there ways you would suggest to activate the sensation in the affected areas?

    Thanks much


    • Numbness from cutting the microscopic skin nerves around the harvest incision site is very common after ACL surgery. It is hard to avoid due to the nature of the nerve locations around the knee. It tends to persist forever although it often gets smaller over time. Most patients don’t notice it other than females when they shave over the area.

  10. doctor my name is armando. I tore my acl back in december to have it diagnosed on january and had surgery march 1st of this year. Ortho said that my acl ripped off and healed to my pcl plus i had no signs of an unstable knee if felt normal until i tried playing once more and when pivoting and changing direction on a play my knee gave away so i opted for surgery. it has now been almost 4 months since my surgery and my knee feels awesome at times i even forget i had surgery. Doctor said my progress has been impresive even after i had no pt did everything on my own at home. i have full range of motion and my strength is about 80% to what it was before. i do get a bit scared because i feel my knee incredible and sometimes think something happened to my graft but doctor says its ok. i was wondering can your graft rip off with everyday regular activities as walking just hanging around or is it very secure? another thing is that is your graft weaker than the original acl or can it resist as much presasure as the original?
    thanks for taking the time on replying to this post it is very important to me

    • Typically when the graft has fully incorporated, it is as strong or stronger than the native ACL. Regaining full strength of the lower extremity is important to minimize the risk of tearing the graft. If all goes well, the graft should not be at risk during activities of daily living. If there are specific concerns about your graft, though, I would check with your surgeon.

  11. Hi Dr.Geier, I am a 16 yr old female that is about 48 weeks postop. I had patellar tendon autograft used, with some meniscus repair. At this point, I feel as though my knee is about 95% to where it was before. I returned to soccer at 7 months post op, and have progressed to playing comfortably. Although I still play on the same on the same team, I am not as good of a player as I was before. Whenever I ask my coach on what I can do to improve, he says that my health and my knee will not be at 100% until 2 years postop. Are there any doctors that believe that the full recovery time is this long?

    • I think most sports medicine surgeons feel that 12 months is a usual time for athletes to return to feeling like their knees are back to normal. It does seem that many athletes feel that it is their second season back before they feel comfortable on it and don’t think about the injury and the knee.

  12. Hello Dr. Geier. Great articles and information. My 15 y/o daughter had surgery on her acl and meniscus in Feb. after an injury during a soccer game. She was recently cleared to full practice and play. She wearing a Donjoy brace for play and practice. I have two questions:

    1. You refer to specific warm-up exercises that may help prevent injury. Do you have these listed somewhere? My daughter does seem to do some warm-ups specific to her, but I would like to see if there is more she should be doing to help prevent another injury.

    2. The Donjoy brace does somewhat limit her speed. But she is getting faster as she is getting used to the brace. Is it realistic to expect she will get back to full speed while wearing the brace? She was told to wear it for 6-12 months.

    She has had a very remarkable recovery, and feels great. She is being eased back into game play, which is the smart thing to do. But she can’t stand it! She wants to play the full game as she did previously.

    Thank you again for the site.

    • I don’t have these exercises in a format that they can be distributed online. I think they need to be done under the supervision of an athletic trainer or physical therapist. I wrote a column about it that you might read.

      As for a custom ACL brace, I don’t typically require athletes to wear them after primary surgeries, but some surgeons do. You might ask her surgeon about risks and benefits of playing without it based on her surgery and rehab. I hope that helps!

  13. At this moment I am on day 68 after a complete tear of my ACL, with partial tear of miniscus, mcl. Knee was practically locked for the first few weeks, but then a violent pop allowed me to regain mobility. Extreme physio has followed, but very specific, very proper regime. Looking extremely likely that surgery will not be needed. Feeling like I can already return to the game, but we have a few more things to focus on.

    My biggest issue, with so so many articles on this topic, is the failure to mention pre-surgery physio. After surgery you will drop significantly (atrophy speaking). With physio before surgery, you will drop less and have a head start to recover.

    From my own experience, and from stories from my physio people (who deal with professional athletes), a year after surgery (and/or a year after injury) should be a thing of the past if the process is done properly.

    Why is there not more education towards pre-surgery physio???

    • I am a bigger fan of preoperative physical therapy before ACL surgery for many reasons. I actually have a blog post about the idea coming in the next few weeks. Thanks!

  14. I have today finally found out that I have completely torn my ACL and damaged my meniscus after sustaining the injury 2 months is my non dominant leg (left) the consultant also told me I had fractured my shinbone at the top of the joint but this was insignificant?! I play football (soccer) And he has told me I can’t play again after the acl reconstruction . I’m 24 and the way I play relies on my speed agility. would I stand a better chance of returning to the game if I played in a different position? I’ve never had any other major injury so I’m finding it difficult to accept that I just cant play again.

    • Generally return to sports rates can be good for athletes after ACL surgery, but it can take quite a bit of time and work, often 12 months or more. The goal whenever we do ACL surgeries is to allow patients to return to their desired sports or activities. There can be some variations depending on factors specific to each patient, though.

  15. Thanks for your response. Could you tell me, would you treat a patient differently if your only goal was to stabilise the knee rather than to help the patient return to their sport? Would the surgical approach be different?

  16. Hello Doctor, I’ve had this concern for the past two years. I’m currently 20 years old, back when I was 17 I had a knee injury (lateral meniscus & medial meniscus tear) on my dominant leg. A month from the injury I had surgery, after two months of therapy treatment I was able to play soccer that year (I felt physically well, as well as mentally). A year later, I suffered a second injury but this time on my opposite knee. My doctor has approved that it is the same injury as my last one, but unfortunately due to financial issues it’s until this following year that I will undergo surgery. My question is, is it safe for me to go back to play collegiate soccer Division III? All my life, soccer has been my passion and I’ve had many opportunities to play at a pro level, but due to the injuries that has not been possible.

    • I really cannot give you a specific answer to your question, as I haven’t seen you as a patient or examined you or seen any radiographic studies. Generally an ACL-deficient knee can be unstable. An athlete with a knee that buckles or gives way with jumping and landing or cutting and pivoting can do damage to the meniscus and articular cartilage. Some athletes do well in an ACL brace and can play without surgery, but frequently athletes need surgery.

  17. This article (plus the references) was exactly what i was looking for.I reconstructed my non-dominant knee in 2007, when I was 21.After 12+ months and a big fluctuation in my weight (another factor that must not be ignored in my opinion),I returned, and I was better than before.Having “the fear” at first,made me better tactically and technically.Unfortunately, two months ago,while being 26 and in my best physical condition ever, I tore the contralateral ACL.I will undergo surgery again because I am still very active but to be honest I don’t know if I ll try to return again, at least not at the same level.The reason is that 1. The surgery and the Physiotherapy following costs a lot! 2.It took me a lot of time to recover then, but in the future I won’t have the option for a third injury (with my job, lack of free time etc.)

  18. My daughter is 13 years old and very very active. She plays soccer, basketball and softball all at a highly competitive rate. She is a very fast runner. She hurt her knee doing a jump stop in basketball as another girl slammed in to her. She was helped off the court and then wanted to go back in a while later I told her no. We couldn’t get an appointment for 3 weeks to see an Orthopedic. In the mean time she has been able to walk and run but the knee would buckle when twisting. She is very athlete and determined her knee hasn’t really been bothering her. I finally got her to the doctor and they did an MRI. The doctor called me back yesterday and said she has a total tear of her ACL, a Medial meniscus tear and a sprained mcl.
    My questions are will she ever be as fast as she was? her dream is to play professional soccer or softball will she still be able to do this? she is only in 8th grade and has had many people already looking at her. She starts high school in 5-6 months and wants to be ready for soccer is this possible? Sports is her life and without them she would be totally devastated will she be able to continue at the same rate she has been after the surgery?

    • Return to sports rates are good after ACL reconstruction surgery. Return to play is more likely than if an athlete doesn’t have surgery. It is a long, difficult process, though. It takes many athletes 12 months or more to return to the same level of play.

  19. Hello drdavidgeier,

    I’m a college soccer player and I torn my dominant side ACL. I’m 4 months out of surgery. I had a patella tendon graft. Rehab has been going great. Looking ahead,I pretend to play next fall if I’m healthy. For soccer players, what are the best options for knee braces coming back to sport? My doctor recommended DonJon, but i tried on and it feels extremely unconfortable.

    Please let me know what your thoughts are!

    thank you

    • I don’t know that I have a strong impression. I don’t make athletes wear a custom ACL brace after ACL surgery unless they feel better in them or need one for a small number of reasons. I think the custom braces are more comfortable and protective, so I usually recommend one if the patient and I decide to go that route.

  20. I had ACL surgery a year and a half ago, I’ve been back to playing soccer for about a year now. My surgeon said I’d need to wear my knee brace for a year after my surgery. Do you think it would be an okay idea to stop wearing it while I play? I’m afraid of tearing it again, but I feel like I’m a much better player with out it. Please help!

    • I can’t tell you what to do since I am not involved in your care. Generally if an ACL surgery is performed well and the patient regains strength, motion, balance and all functional abilities, a custom ACL brace is not necessary for sports.

  21. Injured my acl about 6months ago playing football (soccer) I’ve had an MRI done and there is a problem with my acl but my surgeon just said there’s a problem and that he did not see a tear. I received physio for 3 months at the start of my injury and was told I could return to the pitch to play, in the warm up I felt a crunch and hit the floor, I’ve not had an operation done as the surgeon says my knee is stable and it’s probably a confidence issue and that I was to get a second opinion. I need to play again but feel like I’ve been left chasing my tail not knowing what to do. I can sprint, jog, run and jump but Ive not tried pivoting quickly and this is what could hold me back. Your advice would be much appreciated

    • Unfortunately I can’t say too much without examining you and looking at your studies. The problem with an ACL-deficient knee is a lack of stability with landing and rotational movements. It is important to know if an ACL is providing stability to the knee if there is a partial tear or other degree of injury.

  22. I’ve just torn my acl on Sunday after 10 minutes playing our local rivals, the goalkeeper wiped me out, half going for me and half for the ball I think. I’m 33, been playing since I was 8, the doctor has put me I a full leg cast until the swelling goes down and he can operate. What would you give my chances of playing again? After looking at the MRI results, doctors reaction wasn’t good. @ Ross, hope you get sorted out lad.

    • I don’t know that I can say any more specifically in your case. Generally rates of return to sports at the same level after ACL reconstruction at 12 months fall between about 50% and 85% in most studies.

  23. Very informative blog post!! I’m currently recovery from my ACL reconstruction and I’m wondering, how do I know if my knee is ready to return to sports? Thanks in advance!

  24. Hi Doc,

    In 2012 (june) I tore my ACL, MCL and PCL in my right knee, when I was 16 recon in July. Currently 2014 I have returned to running, and have started training in football (soccer) again. But I feel as if my knee isn’t the same, and therefore I feel as if I cant fully do what I was capable of beforehand. Is this because I haven’t been doing the certain activities for such a long time? And will this get better with time, I still feel that it is more psychological and me not wanting to get injured again, will this go away with time?


    • Return to sports after a multi-ligament knee injury can be very difficult. Fear of reinjury, like we see in ACL injuries, can be part of it. Also it seems to be harder for a patient to regain full motion, strength and function. Working for as long as necessary with a sports physical therapist can be helpful in overcoming those factors.

  25. Dear sir my son is 18 y. Old had acl r 9 months now he had a flexion limitation that is improving he is asking to go to play football on recreational level he is afraid of reinjury. As well me I am asking if there are objective criteria to base a decision of returns to play advice, so we can avoid re injury he is still doing his physeo classes. Thank you in advance

    • I’d ask his orthopaedic surgeon and physical therapist. There are many factors that guide the return to play decision.

  26. hi, im a 16 year old soccer player. I’m injured with a torn ACL. is it true that i can do physio and play soccer without repairing my ACL before I’m 18? then when I’m 18 id have to do the surgery? or is that just nonsense?

    • If a patient has no giving way or buckling of the knee despite a torn ACL, in theory he can return to sports. Most active people have instability of the knee with sports that require cutting or pivoting, so they end up undergoing surgery to avoid further damage to the knee.

  27. Hi,

    I’m 30 year old healthy male, been playing soccer all my life. I have my ACL reconstruction in August 13, so 9 months ago. I’ve not played soccer since, but want to play at the weekend in a casual game with my mates. Do you think 9 months is enough time? I only want to play for 5 minutes. my operated leg is not the same as my good leg yet, and still a bit smaller in muscle mass.
    Thanks, Paul

    • Paul, I can’t say when an appropriate time for return to sports is specifically for you since I am not involved in your care. Generally we like patients to have full strength, motion, and functional ability back in the involved lower extremity. Your orthopaedic surgeon can advise you about return to play.

  28. My daughter had ACL reconstruction, returned to play at 6 months and tore it again. She is now 1 year post-op from the second surgery and has just started to play again. Not surprisingly, she is fearful of re-injury and every ache and pop scares her. My question is this…how much pain is normal as you get back into playing a pivot sport again (soccer, in her case)? Are little pops normal (scar tissue)? Swelling? She did PT, Sports Performance Training with PT, and then track prior to returning to soccer so she’s in good shape.

    • Usually athletes don’t have much pain or swelling once they are ready to return, although fear of reinjury is not uncommon, as you mentioned.

  29. hi I am 32 years old I fully ruptured my acl last august. I have had to wait a year for my operation which is in September. will I play football (soccer) again? it is my passion and I hate to to think that is it!what do u think?

    • I can’t predict your outcome, but I would ask your orthopaedic surgeon. Generally studies have shown that 2/3 or more of patients who undergo ACL reconstruction return to sports within 12 months.

  30. hello doc…i have undergone a ACL reconstruction surgery but due to late operation i have ham my lateral meniscus damaged and it was dislocated at the time of injury….and the lateral miniscus was removed during the operation ….my question is can you kindly give your suggestion wether i will be safe to play soccer ??

    • Return to sports is more a question of regaining full motion, strength, stability and function. The question after a meniscectomy is the development of long-term degenerative changes.

  31. Hi.. Firstly your articles are great, seeing the facts actually gives some confidence that my knees may get back to normal. I just wanted to hear your thoughts on cracking and popping in the knees. I’ve had both knees operated on, non dominant first and a year later the dominant one. My dominant knee feels far stronger than the other at this stage than the other did. The one thing I’ve noticed is a feeling of looseness in the knee when turning but without instability and the odd cracking or popping feeling in the joint. I was wondering if you’ve heard of this and if it’s a problem that needs addressing?

    • I can’t say specifically in your case, but popping or cracking can be common in knees after surgery without significant issues causing them. Also, if there is some wear of the articular cartilage underneath the patella, it can cause those symptoms as well. Good luck!

  32. hi doc.. i done with my acl surgery last year july.. so i build my muscle back slowly bt every time when i play gt abit pain..last week in game i had tackle my knee gt swollen after two days my knee leds swollen bt i cnt bend my leg behind.. so what i should do now? i want to return fully again..

    • I can’t say without seeing you in examining your knee. I would consider seeing an orthopedic surgeon to get a diagnosis and treatment plan.

  33. Hello,
    Well i have a lot of questions. I read this and its great. I just had surgery on october of 2013. I needed to get done a rescontruction of my ACL and LCL .I also my meniscus repair as well.all those injuries occured on my left knee. my nondominant leg. My question is is it possible to get back on the field soon? I tried to run but i cant run like before. even walking hurts so much. I get tired quickly. I gainged alot of weight to :( i feel like im not the same. Im only 18 years old and im a female. I m about to start my freshman year in college and i wanted to play there! but sadly i can’t this year. Do you think i could play in the future ? knowing all those reconstruction that i had?

    • Generally return to sports after ACL reconstruction takes 6-12 months, but some athletes can take even longer. A concurrent meniscal tear or LCL tear could theoretically extend that time or decrease the success rates. It is hard to say in your case specifically, but your orthopaedic surgeon and physical therapist can help guide you to the quickest and most effective means of returning to play.

    I’m a female and just turned 23 this past July, and have played soccer since I was four years old. I started club soccer when I was eight and played year round throughout high school, which I played competitively all four years of high school, and was captain by my senior year. My last tournament playing with all the girls I grew up playing with since I was eight fell on the weekend after high school graduation. Last five minutes of the first game, I misread the ball as I was just placed in defense, I missed the trap and immediately turned around to sprint after the ball as an opponent was close on my tail. Suddenly I felt a tug on my back and hit the ground. The whistle blew. The second time a girl pulled on my jersey, not counting the countless offenses to my teammates, and we received yet another penalty kick, no red cards were ever drawn. The opponent, unable to pass me, yanked the back of my jersey while I was in full sprint, causing my knee to hyper-extend backwards and snapping my ACL.
    I was diagnosed a week later by simple orthopedic testing, with the help of my tremendous extensive swelling, diminished mobility and range of motion, paired with extreme lack of weight bearing, and finally officially confirmed by an MRI. It was just the beginning of summer, and did not have surgery and recovery in the forecast. The injury happened June 2009, and I went in for surgery December 2009 using a graft from my patella tendon.
    I was diligent in my physical therapy, and very cautious in working up towards my original activity level at the the time of the assault. I say assault because that girl put her hands on me and assaulted me, leaving me to live with a life long injury with to repercussions.
    The most tedious healing portion of the entire operation was from my patella. Until just recently, five years later, I kneel down on both knee caps equally without feeling much more pain in my right knee. I even experienced patellar tendinitis a couple times trying to get back into normal activity.
    This year, possibly my final year, if not second to last year attending my local community college, a men’s and women’s college league was finally initiated, and I was asked to play from being seen in the numerous indoor classes I have attended over the years. I was ecstatic, having the chance to play competitively again as this very opportunity was ripped away from me a week after graduating high school.
    I trained for two weeks, Monday-Friday, two practices a day Tuesday-Thursday, puling all nighters between work and practices, finding any time between to catch up on sleep. And a week before my first college level game, during a two on one drill, I came in strong with the ball at my right foot, coming to a sudden stop and trying to cut to the left, my teammate opposed the ball with her right foot, and I heard this crunching noise, followed by pain. I immediately stopped, venturing to the outside to take a breather. I walked it off, it hurt, but not that bad, I entered the drill again, this time dribbling the ball down the coned-off outside line and took a shot with my right foot, landing back down on my right leg after launching the ball; and then I felt it, the knee buckle medially and without resistance, I staggered to the side and sat down rocking back and forth a few times trying to cope with the immediate pain I felt. This wasn’t good.
    I had to work that night, power walking for eight hours serving drinks, and the next consecutive two nights. The day after the injury I was able to squeeze in to see an assistant orthopedic, receive X-rays, and schedule an MRI for the following day. The assistant gave me hope, though he felt more laxity on my right knee, he felt a good end-point, and assessing the swelling, which wasn’t bad at all for a possible “re-torn ACL,” he didn’t feel I tore anything, but wanted the second opinion from the doctor who originally repaired my ACL five years past.
    I had a follow up appointment three days after the MRI with my original doctor. He did the same tests, commenting I had more laxity on my right knee, but not stating he felt any endpoint. He told me he reviewed my MRI and though the original radiologist reviewed my results and thought the graft was fine and intact, he thought differently. A second opinion was attained from another radiologist whom is more familiar with reading those type of MRI’s, and agreed with my doctor that it appeared there was damaged done to the graft, and it was torn and folded over on its self, not just scar tissue like the first radiologist thought.

    My biggest issue with all this is it doesn’t feel the same as the first time. My only conclusion is there was quite a bit more trauma involved with the first time, but I still could not bear much weight at all, let alone bend or straighten my leg more then the position it was stuck in for more than a week after the injury. This time, I worked three consecutive nights on it immediately after the injury, and yeah after night two it swelled a little bit, and became more uncomfortable, but not at all like the first time. I had great range of motion even after the worst of the swelling.
    I am now a week out from the injury, and no longer have a limp, I have been religiously icing, elevating, and compressing my knee every chance I get, just stopped taking Ibuprofen and recently incorporated heat, feel minimal pain, little stiffness in the joint, but the doctor mentioned I might have damaged my meniscus, which I think might account for that symptom as well as the all around difference I feel with this injury.
    The first time I injured my ACL, and the six months before I received surgery, I felt the instability. I bent down to low to pick something up that I dropped real quick, my knee gave out. I tried playing soccer recreationally, and the first time I stopped suddenly from a sprint, my knee gave out. I remember playing beach volleyball with friends, I went in low to hit a ball back over the net, my knee instantly gave out; all with a tingling semi-sharp pain that shot through my knee.
    This time my biggest complaint is the stiffness within my joint, preventing me from the fluid gate motion thats normal for me. I wear a neoprene slip on brace at work because the compression feels better and allows my gait to become more fluid. I jog up my stairs with no issues, and just tried doing squats which I feel no discomfort besides the discomfort I felt before in my patella tendon.

    Am I just in denial that Im back to square one with another torn ACL five years later, or is my intuition telling me something is different this time? I broke down, and the depression has set in heavy just thinking about going down this road of surgery and recovery again, this was my worst nightmare, having to do this all over again. I’m scheduled for Sept. 9th, the quickest they can get me in for surgery, and honestly the best time for me with work and school, but Im so conflicted with what to use this time if it does have to be reconstructed, or even depending on the success rate of a second ACL surgery, that its even worth it.
    I don’t think I want to touch another soccer ball ever again, and I can’t even explain how happy I was and enjoying life again in long time before it all came crashing down on me.
    I feel helpless. . .

    • I can’t really give you too much advice without being involved in your care, but I appreciate you sharing your experience. If you do undergo another surgery, I really hope it goes well for you!

  35. From your previous post above you stated that once healed a graft is as strong or stronger than native ACL. Just wondering what study you are using since most articles state that the graft may only have 50-60% of strength. Thank you!

  36. Hi, in Aug 2013 I had a complete tear of my ACL on my nondominant leg. I did the rehab and returned to playing soccer 2 months ago. I trained and played many games. Everything was fine until last week. I’ve gone and torn my ACL & MCL in my other ( dominant ) leg. I’m 34 years of age and I love playing soccer. What I would like to know is (a) are acl tear injuries just a part of my genetic make up and (b) id like to try and return playing but what are the chances of another ACL injury,should I just hang the boots up is what I’m really saying !

    • I can’t really tell you what to do. Tears of the ACL in the opposite knee occur 3-5% of patients. Generally there is always a risk of re-injury of the surgical knee or the opposite one. Still most patient who work hard in PT and have surgery go well have good chances to return to sports.

  37. I had my acl operated 3 months before while playing football and i have been doing my gyming past 2 months and doctor says i should do gyming for 9 more months Can i return on playing football after 9 more months

    • I can’t make that decision for you. Generally if a patient has regained adequate motion, strength, and functional ability of the knee by 9 months he can work his way back to sports.


    SIR, WHAT SHOULD I DO????? AFTER HOW MANY MONTH I WILL RECOVER?????WHEN I’M return on playing football ?????

  39. Hello, I am about 9months post ACL surgery and I am heading to the surgeon next week to see if I am cleared to play sports again. I play soccer and I was wondering if there are any specific Knee Braces to use ( such as particular brands ). I also am asking if you recommend me playing soccer this year or skip a season?

    • There are not particular brands I would recommend. There are very different opinions among sports medicine orthopaedic surgeons about using custom ACL braces after ACL reconstruction. I generally think athletes can return to play 6-12 months later if they have recovered full strength and functional ability. The orthopaedic surgeon and therapist can help to decide that for each athlete.

  40. My 24 year old son is on a 1 year waitlist for ACL repair. His ACL is completely torn and this occured March 1, 2014. He has healed well with physio and would like to get a knee brace to support his knee for a few non-contact sports. Are there specific off-the -shelf designs he should for in this situation? A custom knee brace in Canada is $1600, which is not affordable to him.
    Thanks for any information you can offer.

    • There are braces by companies like Breg and DonJoy that act in a similar fashion to the custom braces but are not made to fit. At least here, the orthopaedic surgeon writes a prescription for one and the company provides it. Stores do not carry them, to my knowledge.

  41. Hi, my name is Devin. I just turned 17 years old and tore my ACL in May at the highschool state soccer tournament. I had surgery done on June 30th, so it has been about 3.5 months since surgery. My knee is feeling strong and I am very anxious to start playing soccer again. I have my brace for when I am able to play and I am already starting to run with it on flat surfaces. The doctor is requiring me to wait 6 months but I do not feel like I need to wait that long. The only problem is I feel completely ready to play and want to get back to my physical play of soccer but ever since the injury and having my brother tear his 3 days before me, I have a large amount of fear. This process has been very long but I just want to play again as soon as possible. Will my surgery protect me from re tearing it because that is what I am scared of.

    • Unfortunately ACL surgery does carry a small but real risk of rerupture of the graft. Fear of reinjury is common after these surgeries for many of the patients.

  42. First I thank you for the very useful article, and the very rich website Dr David!

    Male, 26 years old.

    I had ACL reconstruction surgery in FEB 2007 (when I was 19), and went back to less than professional soccer in 2008. Since 2010 I get small injuries in the same knee (the less dominant one) every 3-4 games I play. These injuries happen when I do a sudden move, and usually I have to get off the game and lose the full motion for couple of days before getting everything fine again.

    I saw my Dr recently who confirmed along with the MRI that the graft is sharply angulated. (don’t know what this is supposed to be exactly but understood that its a tear in the ACL)

    I got many conflicting opinions, some advised to do the operation the second time, while others recommended to wear an acl brace specially that I don’t face issues with the daily activities.

    My questions are, considering that I want to keep playing at the current not professional but not easy level:
    – If I play with a non functioning ACL, can this affect other parts of the knee as well?
    – what is better for the long run? say when I reach my 50s, would I be in a better shape if I do it?
    – is the second operation more difficult with less likely to get alright results?
    – and finally what do you suggest me? (or as I know that its not easy to answer this over the net), how can I form a decision while surrounded by different opinions?

    • Generally the concern playing sports with a torn ACL or ACL graft is knee instability. If a knee is unstable, the athletic person can damage other structures in the knee, like the meniscus or articular cartilage. Yes, generally revision ACL reconstructions have good success rates, but not as good as primary surgeries.

    • You would have to ask your surgeon for specific advice, but for many knee arthroscopies, riding a bike is acceptable in the early weeks after surgery.

  43. This is the conclusion of my knee overall.

    1. Complete rupture of the anterior cruciate ligament.
    2. Focal subcortical marrow oedema/contusion in the lateral tibial and femoral condyles.
    3. Moderate knee joint effusion.
    4. Grade 1 sprain of the lateral collateral ligament

    I am going to see my specialist on Monday coming up. Do i need to have an operation? I’m 27 years old & play semi-professional soccer. I did this twisting it in a charity match. Is this injury really bad?

    Please help me out.

      • Yeah I understand that.. But if I do my rehab properly etc.. Would I come back the same? I’m really stressing out & don’t know what to do :(

        In the mean time should I do heaps of core & strengthening work on my hamstring/quads?

        • I am still doing my pre re-bab. Getting my hamstrings & quads stronger by the day.. Do you suggest once i do my operation I use my patella or a peice from the hamstring? Thanks

  44. Hi sir….i got my Knee injure on 1st dec 2014 during playing soccer and i just got my surgery last friday 19 dec 2014… use two harmstring graft to replace in acl but nearly a week pass my leg still cannot raise up, is it because of harmsteing problem or i need more time to train ?

    Can you tell me how long can i return to the soccer field, or i have no chance to return? I can tell you true soccer is a part of my life and i really worry that everything will change by my current situation…….

    Do you have any clue to make my Knee (ACL) better and can return to sport as before?

      • It can take patients 1-2 weeks to regain the ability to perform a straight leg raise and up to 6 weeks to regain full knee motion.

  45. I am about 10 months out of ACL surgery and have successfully made it back to playing soccer at my normal level! I got back to playing after 7 months, but what I was wondering is a knee brace necessary to wear and if so how long? I know this depends on a lot of factors, including the surgeon. Also is there any research that says knee braces are or aren’t beneficial? Thanks!

    • Some orthopaedic surgeons offer a custom ACL brace to patients after recovery from ACL reconstruction, although I don’t think there is any research that suggests it is necessary, especially for a first ACL surgery. Thanks for the question!

  46. I tore my acl and meniscus in 2013 one day before thanksgiving during high school soccer practice, i had no insurance. And had to wait and abundance of time to get my surgery. During that time period I was scared and didn’t receive any help or didn’t work out at all. But when I finally got cleared to have surgery in September of 2014 I was quite excited because I knew I was going to play soon. A few days pass after my surgery I get approved for therapy during this time I felt good and felt confident about my knee. But then for some reason because I turned 18 my insurance stopped and I couldn’t continue therapy. So I start doing things on my own and I don’t know if what I was the correct thing but I don’t feel confident about my knee and I really want to get back to playing college soccer but just don’t know what to do. And hearing all these stories about tearing your acl and never being the same or reingury it and making things worse scares me. I’m really healthy and still do weights but don’t get near my knee when it comes to working out. And I try to go on YouTube to see working out videos for acl and I’m afraid because during work outs for my knee it really hurts. So it’s been a year since I haven’t played or ran and 5 months since my surgery please contact me I have no idea what to do. God Bless.

  47. My 17 year old son had his first ACL repair on April 1, 2013 with a hamstring graft. His knee was injured while skiing. With the help of Physical Therapy and a PT ACL sports program he was back on the soccer field mid August of that year. His PT teased him about recovering faster than MN Viking Adrian Peterson. He worked very hard at recovery. He initially played tentatively, but eventually was back to full strength. He re injured his ACL with a moderate sprain two nights ago. He knows he will not be returning to soccer. He also does cross country and triathlons, so that is good. He is one of the 12% who re injures. He did not wear a support brace as his surgeon believed in making the leg strong enough so you don’t need a brace. His surgeon does only knees and his specialty is open growth plate, which is still the case with my son. I have brothers 6’5 and 6’7. So far my son is 6’3″. Maybe the long legs played a factor in the reinjury. Disappointment in our home. Good luck to others and know that if you work hard you can get to full recovery. SV

  48. i had an acl surgery 2 years i got injured again playing football. my consultant dr said that i want to have an acl surgery again. i am just 19 years old . can i return to ground after having an acl surgery again.?

    • Patients can return to sports after a revision ACL reconstruction, although most studies show the rates to be lower than after a first-time ACL reconstruction.

    • There is disagreement among orthopaedic surgeons and physical therapists about custom ACL braces after ACL reconstruction. Many surgeons have patients wear them, while others do not. To my knowledge, no studies show that they definitively prevent a patient from retiring her ACL after a primary ACL surgery. There may be some studies that show some marginal benefit.

  49. Hello Doctor, I had the surgery a year ago and just yesterday I went to the physical therapist to ask for a professional opinion weather I should start playing football (European) or not. He measured the thigh of both legs and concluded that there is 2 cm difference (metric system), also the pulp was different for 1 cm. He told me that I can start playing football, but I should play carefully. I am looking to read your suggestion about my case. Thank you for your time

    • I can’t say specifically in your case, but generally we like patients to regain full strength and equal strength in both legs to minimize the chance of reinjury to that knee or to the opposite knee.

  50. […] Is return to soccer likely after ACL surgery? | Dr. David … – How likely are soccer players to get back to play after undergoing surgery for a torn ACL? What risk factors increase the chance of reinjury or never returning… […]

  51. Hi, I had my acl repaired 6 months ago (September 2014) and I have recently been told by my physio that my knee is strong enough for me to return to playing football (Soccer). I have been struggling to cope with the idea of reinjuring me knee, especially since my surgeon had said to wait 9months before playing matches again. However, my knee feels better than ever and the strength in both of my legs is equal. I have put everything I can into my rehab so I really want to play, especially as it’s been such a mental battle for me to miss out on playing! I was wondering on what your thoughts were about playing now? I know that most people are fine returning after 6 months, and my physio is really happy, but i’m still unsure and would like another point of view!

    Thanks :)

    • I can’t say in your case without being involved. If a patient has full return of strength and full functional ability, it is possible to return to play in 6 months. I understand the concern about returning too soon, though. I think generally the surgeon and physical therapist can offer the best advice, and a patient can slowly try it out on the field, gradually increasing activities.

  52. Hi Doctor.

    I am 24 year old female, nearly 2 years ago I received a high grade ACL tear whilst playing soccer. The knee doctor said I didn’t need surgery and said physio will allow me to return to full activity. I was lazy with my rehab and now I’m regretting it. Is it too late? I have full stability, yet I can’t sit my butt on to my heels without the feeling of a balloon expanding in my knee (with high discomfort). The reason I’m asking is because now whenever I bend down or walk I can hear excruciating loud, unhealthy sounding crunching in the knee. I feel no pain when It crunches. Would you say rehab isn’t too late?

    Thanks in advance, Doctor.

    • I can’t speak to sounds or symptoms specifically with your knee, but generally ACL reconstructive surgery can be performed even years after the initial injury.

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