Make an informed decision by considering what was injured, what you want, and after discussing it with health professionals such as your Orthopaedic Surgeon and ACL Sports Physiotherapist. Some things to consider are:
1. Does your knee buckle or give way when supporting your weight? If it does give way, especially after a period of rehabilitation, you may be more likely to benefit from surgery.
2. Consider the type of sports and activities you want to do. Surgery is more commonly recommended if you want to return to sports that involve cutting and twisting motions such as AFL, rugby league, netball, skiing and touch football (Myklebust 2005).
3. Have you also injured your meniscus? Combined meniscal tears with an ACL injury may have increased rates of knee osteoarthritis – but not necessarily more pain (Oiestad, 2010). This should be discussed with your surgeon.
4. A recent study of active young adults with ACL injuries found that there was no significant differences between patients who had immediate reconstructive surgery followed by rehabilitation, or those patients who had rehabilitation first, then surgery up to 12 months later (Frobell 2013). This indicates that rehabilitation should be considered as a primary treatment option for these patients.
What's involved in rehabilitation and RECOVERY after ACL reconstruction SURGERY?
A surgical reconstruction does not mean you don’t have to do rehab! Rehab is essential for recovery after ACL surgery to build up strength and coordination, and prevent reinjury.
There is no fixed time frame for rehabilitation after ACL reconstruction. Although there are very general guidelines, rehab should progress based on how well you perform in tests of strength, coordination, balance, hopping, agility and fitness (Adams 2012, Myer 2006).
For the first 2-3 months, physiotherapy is intensive – weekly. But if you are really diligent with your program, the need for regular physio sessions is less.
It is recommended that you have at least monthly reviews for 12-18 months after your ACL reconstruction. This is especially important to keep you on track so that you have full recovery after ACL reconstruction, and are at a reduced risk of re-injury.
When can I return to sport after a n ACL reconstruction?
Every ACL reconstruction has different time frames depending on your goals. Returning to sport should be based on when you can safely and confidently perform a whole range of tests that assess your physical abilities.
In addition, you should feel confident in the knee (Thomee 2011, Arden 2011), and successfully perform drills and skills that are specific to your sport or activity. Your sports physiotherapist can use a whole series of tests so that you can track your progress, and identify where your physical performance could be improved.
These include specific hopping tests, and strength dynamometer testing, using specific strength testing equipment.
Am I at risk of reinjury after an ACL reconstruction?
Unfortunately there is a small but increased risk in rupturing your repaired ACL when you return to sport. This is true for both your injured and non-injured legs (Hewett 2013). But take heart, this risk can be reduced if you stick to your rehab plan for whatever time it takes to improve your physical abilities (Manske 2012). Generally this is between 12-18 months.
Adams, D., et al., Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion–Based Rehabilitation Progression. The Journal of orthopaedic and sports physical therapy, 2012. 42(7): p. 601.
Ardern, C.L., et al., Return to the Preinjury Level of Competitive Sport After Anterior Cruciate Ligament Reconstruction Surgery Two-thirds of Patients Have Not Returned by 12 Months After Surgery. The American journal of sports medicine, 2011. 39(3): p. 538-543.
Eitzen, I., Holm, I., & Risberg, M.A. (2009). Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 43(5): 371-376.
Eitzen, I., Moksnes, H., Snyder-Mackler, L., & Risberg, M. A. (2010). A progressive 5-week exercise therapy program leads to significant improvement in knee function early after anterior cruciate ligament injury. Journal of orthopaedic & sports physical therapy, 40(11), 705-721.
Fitzgerald, G. K., Axe, M.J. & Snyder-Mackler, L. (2000). A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surgery, Sports Traumatolgoy, Arthroscopy 8(2): 76-82.