Sports Physical Therapy Institute

So you've injured your ACL, joining the thousands of people who do this every year- but now what?  Unless you know someone who has injured theirs or you are a serious athlete, chances are you couldn't even point to the area of the body where your ACL is located (it's in your knee, by the way).  Here at Sports Physical Therapy, we have treated hundreds of ACL injuries and most people have the same questions, so we thought we'd share some of them with you. 

1.  What is the ACL and what does it do?

The anterior cruciate ligament (ACL) is one of 4 ligaments of the knee joint.  It connects the femur (thigh bone) to the tibia (lower leg bone) and provides stability in the knee joint.  More specifically, the ACL prevents the tibia from sliding forward or internally rotating independently of the femur.

2.  Is surgery necessary if I have torn my ACL?

Not everyone with a torn ACL requires surgery.  Surgery is usually recommended for younger patients, those wishing to return to sports or activities involving frequent cutting and changing directions, and athletes in competitive sports.  Unfortunately, when the ACL is torn, there are often additional injuries to the knee such as a meniscus tear, which may make surgery necessary.

3.  Should I have physical therapy prior to my surgery?

Many surgeons require their patients to have physical therapy prior to surgery to decrease swelling and increase range of motion and strength.  It has been our experience that patients who have preoperative physical therapy and achieve full range of motion, minimal swelling, and good strength prior to surgery, typically have better rehabilitation results.  Ask your doctor if pre-op therapy may help you.

4.  If I opt not to have ACL surgery, what can I do to help my knee improve?

Patients who have torn their ACL and have decided not to have surgery should see a physical therapist, who can design a specific treatment plan, which will include stretches and exercises to restore leg muscle strength, range of motion in your knee, and improve balance and proprioception (your body's awareness of joint position). In addition to the exercises and stretches, your therapist should manually work with you every visit. Physical Therapy is usually prescribed for 3x/week until you are maximally rehabilitated.  You may also receive an ACL brace to wear during sports or physical activity to help stabilize your knee.

5.  How is the surgery performed and what is used to replace the ligament?

ACL reconstruction is an outpatient procedure (in and out the same day), in which a graft will be used to replace the torn ligament.  There are 2 types of grafts- autograft (from your body) or allograft (from a cadaver).  The 2 most common grafts used are taken from the patellar tendon or the hamstring tendon.  There are advantages and disadvantages to both autografts and allografts and your surgeon will discuss with you which one would suit you best.  Using an autograft generally provides a stronger graft, but recovery can be more painful due to the additional surgery required to harvest the graft from your body.  An allograft tends to produce better recovery results- less pain and swelling, however risk of infection is slightly greater and these grafts are usually less stiff than an autograft. 

6.  What should I expect immediately after surgery?

After surgery, you will be groggy from the anesthesia, but can go home once most of those effects have dissipated (you will need someone to drive you home).  Your knee will be wrapped in a dressing, placed in an immobilizer or brace that will keep your knee fully straightened, and will be required to use crutches.  You will most likely be prescribed pain medication and be instructed to take one aspirin a day to prevent blood clotting.  It is a good idea to get these prescriptions filled ahead of time (if your doctor will allow it) to minimize post-operative stress.  Some surgeons will have you utilize a CPM (continuous passive motion) machine immediately after surgery, which will automatically bend and straighten your knee very slowly. 

7.  When can I start physical therapy?

In our experience, the sooner the better.  At our facilities, we typically see patients 2 days after surgery, where we will remove the bulky dressing, clean the wound, and redress the site with a smaller dressing.  We will also begin gentle range of motion exercises and give you a home program to help start your rehabilitation.  We have found that patients who see us 2 days post-op come in feeling very uncomfortable and sore, but leave a great deal better.  It has been our experience that the longer you wait to begin physical therapy following surgery, the more difficult and painful it is to restore your range of motion and strength.  Discuss therapy with your surgeon before your surgery, so you can set up your appointment in advance.

8.  What will my rehabilitation be like?

A physical therapist will design a specific exercise program for you to restore joint mobility and strength.  Your physical therapist will use manual therapy techniques such as joint mobilization, soft tissue mobilization, and PNF (Proprioceptive Neuromuscular Facilitation) techniques, as well as modalities such as ultrasound, ice, and electrical stimulation.  Don't worry if you don't understand these terms, your therapist will explain all aspects of your therapy program.  You will most likely attend therapy 3x/week until your knee has been maximally rehabilitated.  The therapy process may be difficult at times (especially in the beginning), but if you have a positive attitude, work hard, and play an active role in your therapy, you will be better before you know it.

9.  How long will it take until I can return to sports or regular exercise?

Each patient recovers at their own rate and your physician and physical therapist will determine when you are ready to return to sports.  Factors such as type of sport or activity, and if there were coexisting injuries in addition to the ACL tear (meniscus tears, other ligament tears) will be considered before you are cleared to return to normal activity level.  That being said, you can generally expect to resume activities 6-12 months following surgery.

If you have torn your ACL, it is important to discuss all options with your doctor to determine which route is best for you.  These questions are the more common ones we field, but if you have more specific concerns, you can always contact us through email at princeton@sportspti.com. Good luck with your rehabilitation however you decide to go about it.  Remember, with the right rehabilitation, you should be able to get back to all activities you enjoyed before the injury.