We Can Rebuild It – Rehabbing after an ACL Repair

Preventing an ACL (anterior cruciate ligament) tear is something that we’ve discussed before, where we provided some info on some common predictors for ACL tears. Knowing this info is fine and dandy, but what if you have already had an ACL tear? Whether the tear was this morning or you had it repaired 3+ years ago, there are a lot of things that are important to consider. Proper ACL repair is paramount.

If you just had (or are suspicious of) an ACL tear, you need to get examined immediately to confirm a tear. This will usually involve an MRI. Assuming you did indeed have a tear, you’re likely going to require surgery to repair the ligament. If you’re fresh out of surgery, or only a 1-2 months into your recovery, this article isn’t really intended for you yet, but the info will be helpful soon. If you’re at least 4+ months out of surgery and you’ve progressed enough in your rehab that you’re looking to get back into sports in the next several months, pay attention!  Here are some really important factors to consider that will help you rehab your ACL repair and get back out there better than before.

    • Quadriceps strength – Your quads can never be too strong, so get them strong.  Regardless of your sport or activity of choice, having strong quads will significantly reduce your risk of reinjury.
    • Hamstring strength – The quads usually get all the glory when it comes to any knee injury, but the hamstrings are incredibly important, especially for the ACL.  Having strong hamstrings helps prevent your knee from hyperextending, which is a common way to (re)injure the ACL. Another factor to consider is that ACL repairs usually take an autograft, or piece of tissue from your body, to replace the torn ACL.  For ACL repairs, the hamstring is a common source, which means you also had an injury to your hamstrings when you had the surgery! Bottom line is don’t forget the hamstrings.
    • Have a plan – Understand that someone going through an ACL repair rehab program will end up effectively taking a full 12 months to feel solid for full return to sport.  It’s not uncommon for people to return to play in 8-9 months, but this isn’t generally recommended as reinjury rates following ACL repairs are still fairly high.  There are typically weaknesses that are observed in the repaired leg even up to 9 months after surgery. As such, it is highly recommended that people are continuing with rehab for at least 12 months after surgery.  The short version of this story is that if you are serious about continuing to participate in sports long term, plan to be out for a full 12 months before you’re playing in competitive games. Knowing this will allow you and your rehab team to fully plan out what you’ll need to be able to accomplish so that you’re ready by the end of those 12 months.  Participating in practices and sport related activity is expected toward the latter months.
    • Symmetry in leg strength matters, kind of – Leg strength symmetry is one of the most tested and researched focuses with ACL rehab, which makes a lot of sense.  The majority of the time, one leg was injured and one wasn’t The issue with this is the uninjured leg tends to get weaker from underuse during the rehab process, so the comparison doesn’t exactly work.  The current standard for symmetry is also that the legs need to be within 90% for various tests. This effectively means that we’re saying that we want your repaired leg to be 90% of the other leg that is now weaker than it usedto be when you got injured.  What we really need to see is that the legs are as fully symmetrical as possible, and that the uninjured leg is being heavily challenged throughout the rehab process to make sure that it is at the very least not getting weaker.

As far as preventing reinjury, quad strength is the biggest predictor of success or failure. Our previous article on ACL injury prevention (linked here) is another good source of info to check out. You and your rehab team should be working on a lot of stuff – core work, single leg exercises, balance, jumping, running, cutting, conditioning… it’s quite a list.  Think about everything that you do in a sport like basketball, football, soccer, etc. and make sure that you’re integrating sport-specific skills into your program.

Getting through a ACL repair is a long, tough process. Knowing where you need to be and what to focus on is vital for success so you don’t end up under the knife again.

Got questions?  Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR or Albany, OR can show you how to discover your future without limits. Follow us on Facebook.

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified healthcare professional or your primary physician for any personal concerns.

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