Maybe you’re playing a sport when it happens — you hear a pop, and then your knee feels painful and unstable. You’ve torn your anterior cruciate ligament (ACL), and when your doctor takes a look, you find out surgery has been recommended. Of course, you want to get back on the field or court as quickly as possible.
Anup Shah, MD, an orthopedic surgeon at Banner Health in Phoenix, AZ, shared what to expect, and what you can do to speed up your recovery.
What should you do before ACL surgery?
The timing of the surgery often depends on other ligaments or cartilage that may have been damaged at the time of the injury. If you have an isolated ACL tear, your surgeon will probably recommend that you obtain the range of motion in your knee before surgery. That will decrease the chance of knee stiffness after surgery and potentially another procedure in the future.
If you have damage to your meniscus or cartilage, range of motion exercises could further injure your knee. In that case, your surgeon may recommend surgery sooner.
Strengthening your quadriceps muscle as much as possible before surgery is helpful, as this muscle group often atrophies and weakens after surgery. “After surgery, with the swelling and trauma, the quadriceps often shuts down,” Dr. Shah said. Keeping your quadriceps activated can help get you moving and walking more quickly after surgery.
Your surgeon will also review your medications before your surgery and let you know which ones you should stop taking. Nicotine cessation is highly recommended as smoking can increase complications after surgery.
Dr. Shah also recommends setting yourself up for success. That means lining up the support and services you’ll need after surgery:
- Schedule your physical therapy appointments.
- Make sure the surgery center knows your preferred pharmacy so you can get your pain medication prescriptions filled.
- Obtain items to assist with pain such as cryotherapy (cooling treatments), pillows for elevation and clothing that’s easy to put on and take off.
- Set up your bathroom so you can move around easily.
- Prepare and freeze meals that you can reheat.
“Preparation for your post-operative recovery is key. The rehabilitation process takes time. Be patient and follow instructions, and your chances of success are high,” Dr. Shah said.
What’s the operation like?
When most people have an ACL repair or reconstruction, they go home the same day, which is otherwise known as outpatient surgery. When you arrive, the preop nurse and anesthesiologist will evaluate you, and then when it’s time for surgery, they’ll bring you to the operating room.
ACL surgery is often done with both general and regional anesthesia. The general anesthesia “puts you under” for the operation. Regional anesthesia uses ultrasound to numb certain nerves that send pain signals, so when you wake up, you’ll have less pain, often for hours to days.
Once you’re under anesthesia, the surgeon will repair or reconstruct your ACL. Most of the time, doctors use arthroscopy for ACL reconstruction, where they use small “keyholes” to drill tunnels and fix your new ACL.
In younger patients, surgeons usually use tissue from the patient’s own knee for ACL repair, which is known as an autograft. In “older” patients, surgeons may recommend donor tissue, which is known as an allograft. The age cutoff is not defined, so your surgeon will discuss your options with you. In some cases, the ACL is detached from the bone, and it can be reattached and braced internally.
When the procedure is finished, you’ll move to the recovery room. There, you’ll be monitored for any issues with the anesthesia. Once you have met the criteria for discharge such as pain control and the ability to transfer yourself safely and tolerate soft foods, you will be discharged.
What is the recovery process like?
Your recovery will depend on the surgery performed. If you had an isolated ACL reconstruction, you will typically be placed on a program that encourages active weight bearing and range of motion. If you had additional procedures, on your cartilage or meniscus, for instance, your doctor may recommend a period of protected weight bearing.
Returning to sports or full activity depends on your recovery process and the type of graft you had. If your own tissue (autograft) was used, your estimated return to sport will be between six to 12 months. If donor tissue (allograft) was used, it will likely be around 12 months.
Your health care team will monitor milestones such as range of motion, quadriceps and hip strength, jumping ability and other metrics, including single leg squat, single leg hop, triple hop, vertical jumping, landing mechanics and others, to determine when you can return to high-level sports. “We want to make sure to avoid any potential issue that caused the initial ACL tear and assure proper metrics before returning to sports,” Dr. Shah said.
He noted that following your doctor’s instructions is crucial after surgery: “Healing and incorporation of the graft to the bone takes time and is not based on how you feel. One of the common causes of failure is premature return to full activity.”
The bottom line
Torn ACLs are common, especially in athletes and active people. If you tear your ACL, surgery can treat it. Maintaining your range of motion and strength before surgery, and following your surgeon’s instructions after surgery, can get you back in the game as quickly as possible.