Normally when a write one of these articles I try to make up a clever or witty headline for it, however for this article I’ve simply said what happens. When you injure your Anterior Cruciate Ligament (ACL) you have a journey ahead of you on your road to recovery. An ACL injury isn’t simply rest it for a few weeks and you’ll be back playing. ACL injuries require a lot of hard work from you individually, alongside your Physiotherapist and Orthopaedic Consultant.
During my time in the Sports Department at one of the acute hospitals in Singapore I would receive approximately three to four new patients coming in with ACL tears of varying levels. Some would go on to receive surgery, whilst those with minor tears and who were not involved in collision, contact or twisting sports opted against surgery. Regardless of whether or not they went for surgery, we would still have a lot of time working together in order to get them back to their prior levels of function, and in some cases even higher.
Regardless of whether it is a full grade 3 tear or only a grade 1, the moment of injury and the following few days are still very painful. Alongside the pain, you will lose function by not wanting to put weight on the leg and loss of range of motion in the knee due to pain and swelling. The accumulative effect of being in pain, having loss of function and being ruled out from participating in sport will also cause low mood and frustration.
Surgical or Non-surgical
Depending on the diagnostic findings of physical examination and MRI findings you’ll either be headed for surgery or you’ll undergo lots of Physiotherapy. However regardless of the decision to go for surgery, during the initial few weeks after injury the treatment will not change; we need to get you back moving again. Decreasing the swelling, regaining full range of motion at knee, getting the muscles in your leg and hip working again are all of great importance for both surgical and non-surgical patients.
Those who are not for surgery will undergo thorough strengthening programs designed and progressed by their Physiotherapist. Lots of work is dedicated to restoring previous strength (if not greater) in the leg, alongside retraining motor programs, balance practice, biomechanics analysis, agility training and muscle endurance. This is not a fast process and requires the patient adhering to their home exercises, and being diligent in attending their Physiotherapy sessions.
Those patients that require surgery are looking at returning to sports in 9 months to one year. Previously patients would aim at being pack on the court/ pitch around 6 months after surgery, however recent research has shown a greater frequency in re-rupture of ACLs when patients return to sport after only six months of rehab. It is believed that still after 11 months most patients still have significant neuromuscular control deficits, and as a result their incorrect movement patterns can put them in a compromised position on landing or cutting.
In the first week post-surgery, patients will start their rehab with bed exercises, with the primary goal being for regain full extension of the knee. The other areas that need to be worked on include; decreasing the amount of swelling at the knee, normalize the walking pattern as able, and maintain hip strength. Once your Physiotherapist is happy with your progress, they will introduce new exercises to increase strength whilst weight bearing which are called Closed Kinetic Chain (CKC) exercises.
After 6-8 weeks the graft that replaces your torn ACL should be strong and stable, at that point your Physiotherapist will progress your exercises provided you have adequate strength and motor control. These exercises are called Open Kinetic Chain (OKC) exercises, and involve you performing a movement with the leg free to move. An example of a CKC would be a squat, as opposed to an OKC being a knee extension. At this time your balance and co-ordination will be challenged and progressed.
Once you therapist is satisfied with your strength, range of motion, motor control, balance, coordination and knee stability they will then being to introduce jogging, hopping, jumping and agility work. At this stage in the rehab the phrase “it doesn’t feel like my knee” is heard regularly. This is because your brain is still trying to interpret the new movements and sensations it is making, on top of re-learning the correct patterns of movement. At times you’ll be scared to take off or land on your leg, but you will only be asked to do this when your therapist is sure that your knee is ready for it.
The big benchmark in a lot of patient’s rehabilitation is returning to jogging or running. This will normally occur around 3 months after the surgery, providing that muscles surrounding the knee are strong enough to be able to support it. Your Physiotherapist will advise you when you can start jogging on your own, but you will initially practice jogging in a safe environment in the gym, alongside having any mechanical or movement issues assessed. Once you’re able to run without any problems, hopping, jumping, turning, twisting, bounding and cutting will able be practiced. Throughout the process we will be continuing to strengthen the muscles at your knees and hips.
The final stage of the rehab pathway is practicing sport specific tasks. Whether that is performing a lay-up in basketball, rucking in rugby, dribbling in soccer. You will then begin training sessions and look towards participation in competitive matches.
If you have any questions or queries regarding ACL reconstructions or any knee issues, then feel free to email email@example.com or book an appointment via our reception.