An ACL injury is one of the biggest fears many athletes have, especially if it requires reconstructive ACL surgery to repair the damage.
The Anterior Cruciate Ligament (ACL) is one of the strong, dense bands of tissue that help connect the femur to the tibia.
It is located in the center of the knee and works to prevent the shinbone from moving forward on the thighbone and it helps stabilizes the knee.
An ACL injury can be extremely painful and may require rehab, surgery, or both for a full recovery.
What is an ACL Injury?
An ACL injury occurs when the ligament becomes partially or completely torn. A milder injury to the anterior cruciate ligament may also overly stretch the ligament, but leave it in tact.
The cause of ACL injuries is usually related to sports or fitness movements that call for sudden changes in direction, quick stops and starts, as well as jumping, landing on the feet, and taking hits.
An ACL injury is common in sports like soccer, football, basketball, baseball, tennis, as well as others.
Common causes of ACL injuries can include some of the following:
- Cutting movements, which require slowing down quickly and changing direction
- A powerful pivot when the foot is already firmly planted
- Attempting to come to a sudden stop
- An awkward landing after a jump
- Taking a direct blow to the knee that causes trauma to the ACL
In many cases, people who injure the anterior cruciate ligament will hear or feel a pop in their knee followed by severe pain, which can make the knee feel unstable and difficult to put weight on.
Symptoms of an ACL injury can include:
- Rapid swelling of the knee
- Intense pain and difficulty bearing weight on the knee
- A feeling that the knee is unstable and about to “give out”
- Diminished range of motion in the knee
Seeking medical attention at the first sign of an ACL injury is important. A physician can help determine the extent of the injury and whether it will require surgery, rehab, or both.
ACL Recovery and Rehab Without Surgery
After a physical examination, including a discussion of symptoms and recent activity, a physician is likely to prescribe imaging of the knee with either an ultrasound or an MRI to get a clear picture of the ACL and rule out other possible knee-related injuries.
Strains to the ACL can include stretching the fibers of the ligament without a tear, a partial ACL tear to the fibers of the ligament, as well as a complete rupture or ACL tear.
All three of these injuries can cause swelling and tenderness.
Rehab for ACL injuries can include some of the following approaches:
- RICE Method, which stands for Rest, Ice, Compression and Elevation. This is very often the first approach, even while a doctor works to gain a better picture of the ACL injury
- Pain and swelling management can often include over-the-counter pain medication, such as ibuprofen (Advil) or naproxen (Aleve)
- Physical therapy that helps strengthening the muscles that contribute to knee stability, as well as improving range of motion
- ESWT Shockwave Therapy
- Prescription of a supportive knee brace
- A very slow return to training and sport
At the first signs of an ACL injury, the emphasis is on reducing pain, inflammation and stabilizing the knee to protect it while healing and preventing additional damage.
ACL Surgery for Anterior Cruciate Ligament
In severe cases of an ACL injury, especially for professional athletes or in the case of an active individual whose knee continues to buckle with normal daily activity, ACL surgery is necessary to repair or reconstruct the damaged anterior cruciate ligament.
ACL surgery can entail the following:
- In ACL reconstruction surgery, a surgeon removes the thoroughly damaged ligament and puts a segment of tendon in its place, a process referred to as a graft
- The tendon replacement may come from another area of the knee or from a deceased donor
- In other cases, the ligament may have been pulled off the bone during injury and a surgeon can reattach it
ACL Surgery Recovery Timeline
After ACL surgery, a person has to complete another round of intensive rehabilitation that lasts, on average, about six months. It’s important to maintain consistency with rehab because it will reduce the risk of continued injury and decrease ACL recovery time.
An estimated ACL surgery recovery timeline might look something like this:
First 2 weeks after ACL surgery
Though people who have undergone ACL surgery will be able to bear some weight on the knee, crutches are used for recovery from post-op pain and swelling.
Physical therapy will likely start during this period, with light range of motion exercises along with some strength training.
Weeks 3 through 6
Continued physical therapy that focuses on strengthening the muscles around the knee using resistance bands and light weights, as well as maintaining range of motion exercises.
Adding a knee brace during this phase of recovery can help support the knee, especially as tools like a stationary bike or step machine are introduced into the physical therapy routine.
Weeks 6 through 24
For many people recovering from ACL surgery, this phase can feel like they have reached a full recovery, though added strength and power training is key. At around the three-month mark, most people are able to run on a treadmill and get much of their mobility back.
After six months, many people are fully recovered, though it’s important to not ignore any knee pain in hopes that it will simply go away.
ACL Surgery Recovery Tips
As noted above, it’s important to stick to the ACL recovery and rehab plan and not rush back into intense levels of physical activity too early. Staying focused during recovery can be difficult, but having specific exercises to keep practicing can help.
Here are 6 ACL Surgery Recovery Tips to the Focus on:
1. Manage the Pain
Pain often keeps people from doing the necessary ACL recovery exercises. Prescription painkillers and anti-inflammatory medications may be taken as prescribed to help reduce the pain. It’s important to communicate with the physician and therapist about all levels of pain.
2. Minimize Swelling and Inflammation
The RICE method is recommended for reducing swelling and pain that causes joint stiffness and can keep the muscles from working properly. Icing three to four times a day for 15 minutes is ideal, and wearing a compression sleeve on the knee for as long as there is inflammation is recommended.
3. Work on Getting the Knee Straight
Pain and inflammation can keep a person from straightening the knee, which is key after ACL reconstruction surgery and during recovery. Extension and stretching exercises must be performed several times daily.
4. Bend the Knee
It is safe to bend the knee after ACL surgery and physical therapists will get to work on this very quickly. But it will also take some effort on the part of the patient, who will need to practice the exercises regularly.
5. Strengthen Other Muscle Groups
The quadriceps is the largest muscle group in the body and loses strength the fastest. Straight leg raises are an excellent way to prevent too much strength loss in the quads and there is no limit to how many of these exercises a person can perform each day.
6. Begin Walking Normally
A full return to weight bearing on the knee is important because it allows the surrounding muscle groups to restore neuromuscular function. Crutches are necessary for the first week, but losing the crutches and getting to full weight on the knee is a key marker in the recovery process.
EPAT / ESWT Shockwave for Post-Op ACL Surgery Recovery
An effective recovery method for post-op ACL surgery is ESWT, which stands for Extracorporeal Shock Wave Therapy, or simply Shockwave Therapy.
Shockwave Therapy is sometimes referred to as EPAT Therapy (Extracorporeal Pulse Activation Technology).
EPAT / ESWT Shockwave Therapy is a non-invasive method for increasing the speed of healing and reducing downtime for post-op ACL surgery.
This painless, regenerative treatment helps the anterior cruciate ligament heal faster by delivering impulse pressure waves deep within soft tissue, and according to studies, improves remnant cell viability, proliferation and migration.
With each session, Shockwave Therapy stimulates blood flow to the ACL and surrounding tissue in the knee, which helps create the formation of new blood vessels and further decreases inflammation.
Other research has shown that Shockwave therapy significantly improves ACL surgery recovery on the Lysholm Scale.
The Lysholm Knee Scoring System measures eight items, such as pain, instability, inflammation, stair climbing, and squatting among others, and is one of the most utilized scoring systems for ACL injuries.
EPAT / ESWT Shockwave treatment for post-operation ACL surgery recovery is an ideal approach because it is effective for breaking up scar tissue after surgery in addition to improving the healing process.
Athletes, as well anyone else, can actually undergo EPAT / ESWT Shockwave treatment sessions during physical therapy and recovery from ACL surgery.
No athlete ever wants to experience an ACL injury, especially if it may require surgery and a lengthy rehabilitation time.
Fortunately, it is possible to recover from this type of injury and get back to regular activities with a proper treatment and rehab plan.