The Anterior Cruciate Ligament is one of the more well known injuries because of its slow recovery time. The
general expectation is for recovery to take 9-12 months.
Why does it take so long?
Well there is a lot involved…
Rehab begins even before surgery (although take note not all ACLs require surgery!). Typically the knee is very swollen, sore, and often ‘unstable’ where things no longer feel secure and balanced. This ‘pre-hab’ phase is all about getting you ready for surgery. This takes the form of exercise and treatment that aims to reduce the swelling, restore your flexibility, and wake up all your muscles that have shut down due to the injury. It is well evidenced that going into surgery more prepared improves outcomes.
After surgery, people are usually only in hospital for 1-2 days. Expect to be up and out on crutches very quickly, and back into physio a few days later. The early stages of management resemble the ‘pre-hab’ phase where the focus is on attaining full range of movement and appropriate muscle activation. Whether any other structures were affected, such as the meniscus or a collateral ligament, will also dictate this phase, as generally speaking, more structures being injured usually means more restrictions as they need time to heal. The graft site, commonly the hamstrings or patella tendon (below the knee), are often also a focus as these muscles are usually sore and also need to be rehabilitated. Think of them as a muscle tear, which usually needs at least a good 6 weeks to start feeling good again.
So you have made it through the first 6-12 weeks and now you are starting to feel pretty good. The overall movement is mostly there, you are starting to do basic load bearing exercises, you are back doing activities like cycling. Next is where over the next 6-9 months you gradually build on all these little bits and pieces. The plan is to get very strong in all the muscles we need. We want to be very confident in our balance. We want to progressively move through straight line running, into turns, into rapid changes of direction. Eventually into jumping, hopping, and sport specific drills. This all needs to be done in a slow progressive manner, while we monitor for any signs of instability/going too quickly.
Unfortunately, the body is a slow learner when it comes to the ACL. ACL re-injury is quite common. Usually it is on the background of not completing a full rehab plan. Expect your physio to take many measures along the way to ensure you are reaching all your goals, so you can be confident when the time finally arrives for play, you are ready!
Watch the video below from one of our physiotherapists, Digby, showing you some recovery exercises!