Returning to normal activities without pain, is the typical goal for people recovering from ACL reconstruction surgery. Some people may even perform at a higher level, after surgery, than before. But a significant number of people who have ACL surgery, never return to their prior level of function. Why? Is there anything that can be done to ensure a successful result?
Studies repeatedly show that surgeons who perform a lot of ACL surgeries (40 or so a year), patients that are motivated and follow directions well, and specialized physical therapy are the best predictors of successful outcomes. All three components must work together as a team to achieve the best results. Many well performed surgeries have poor results due to patients not following instructions or poor rehab. And, no matter how motivated a patient may be, great rehab cannot overcome poor surgery.
Besides skilled surgeons and therapists, and motivated patients, there are several other keys to successful ACL rehab.
- Pre-operative range of motion (ROM): it is important to have (as close to) full extension at the knee. Lack of full extension affects walking mechanics and increases stress to the knee (especially the knee cap), and inhibits recovery.
- Pre-operative strengthening: good quad muscle strength allows for quicker progression (the stronger the leg is prior to surgery, the stronger it will be immediately after surgery).
- Early weight bearing after surgery: reduces the wasting away that occurs after surgery, helps maintain healthy knee tissue (especially cartilage), promotes a stronger repair.
- Normalizing gait: walking normally ASAP after surgery helps prevent injuries to other parts of the body, speeds muscle recovery.
- Minimize effusion (swelling): effusion has been to shown to inhibit muscle activation, cause tissue death, inhibit ROM, increase pain.
- Restore patella (knee cap) mobility: normal patellar movement is necessary for proper knee mechanics.
- Minimize pain: pain inhibits healing, activity and progression.
- Re-establish quad muscle control ASAP: quad muscles tend to shut down after ACL surgery, so extra effort is often needed to get them working properly again.
No one can guarantee an excellent outcome after ACL surgery, but following the keys outlined above will significantly increase the likelihood of an excellent outcome.
Our Knee/ACL Physical Therapy page has info about how we can assist folks to a speedy recovery.
