What Is A Proper Rehabilitation Regimen For An Anterior Cruciate Ligament (ACL) Injury?

Question: What is a proper rehabilitation regimen for an anterior cruciate ligament (ACL) injury?

Answer: The recovery or rehabilitation from an ACL injury, and in particular after an ACL reconstruction surgery, can vary from doctor to doctor and therapist to therapist. But in general, most rehabilitation regimens will have the athlete or patient back to their sport at about six months.

There's a lot that goes into rehabilitating a knee. But in general, what we want to see as soon as possible is resolution of pain and swelling -- obviously, letting the graft heal, protecting the graft during that critical first six weeks of healing. We also want to see return of motion. And finally, we want to see return of strength. Those are the hallmarks or foundation of a good rehab program. How you get there and when you get there varies, again, from therapist to therapist and individual to individual.

We set the six-month return-to-sports point based on healing of the ligament. So that's something you don't really have control over other than protecting it and making sure you don't reinjure it during that critical healing part. But a lot of that just has to do with biology. It takes that long for the ligament to become a living part of your body again. To re-establish blood flow and structure to that ligament that's been really, a tissue taken from somewhere else and put in your knee.

So we set that six months sort of as a benchmark that most athletes or most patients should be back fully recovered by about six months.

Now, when you return to sport can be much sooner than that. And there's some doctors, some programs that will have the athletes back playing their sport as early as two months after the injury. That's based on hitting the marks that you are in control of -- and that is that your knee has the full range of motion, that you have full strength, and really that you have no pain or swelling in the knee.

A lot of folks can get to that point six weeks after the surgery or eight weeks after the surgery, and hence, be allowed to return to their sport earlier than the six-month period. In other words, the ligament is not fully healed into the knee, but it's healed enough that it's strong enough that the risk of re-injuring the ligament is acceptable.

And so, probably the earliest you might want to return to your sport might be two months. You just have to realize that if you do go back earlier -- earlier than six months or nine months or a year -- that your graft is still not fully healed. In other words, it's weaker than it's going to be at six months, and that is a steady graft of healing and strengthening of that ligament. You can jump on that graft and get back to sports at any point along that healing if you're willing to accept the risks.

So if you want to get back to your sport at two months and have regained all your motion, all your strength and you have no pain, no swelling -- and are willing to accept the risk of playing on a graft that is not as strong as it's going to be in six months, that's a personal decision that you make with your trainer, your therapist, your doctor and your coach. But in general, everyone should be able to get back and play at about six months.

Sherwin Ho, M.D., The University of Chicago Medical Center
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