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Understanding ACL Reconstruction Surgery

ACL reconstruction surgery involves replacing a torn anterior cruciate ligament (ACL) with a graft, typically sourced from your hamstring, quadriceps tendon, or a donor. 

This procedure restores knee stability, allowing you to perform activities like running, pivoting, or playing sports without your knee buckling. It is performed by a skilled orthopaedic surgeon using arthroscopic techniques.

While the surgery itself is crucial, it’s only the first step. Achieving a full recovery hinges on a comprehensive rehabilitation program to rebuild strength, power, and coordination. 

Without proper rehab, even a successful surgery may not enable you to return to your previous level of activity.

What to Expect After ACL Surgery

Here’s what research and our experience show:

• Approximately 55% of patients successfully return to sport at their pre-injury level after ACL reconstruction.
• Younger athletes (under 18) face a higher reinjury risk, with 10-20% experiencing another knee injury if rehabilitation is incomplete.

To maximise your chances of a safe return to activity, a 12-month rehabilitation program guided by a physiotherapist is essential. 

And I may be biased, but after rehabbing hundreds of individuals after ACL reconstruction and recently completing my PhD in “Optimising ACL Reconstruction Rehabilitation”, I believe that excellent rehab is the primary mechanism for improving outcomes after ACL reconstruction.

The Critical Role of Knee Rehabilitation

Many patients mistakenly believe they’re ready to resume sports once pain subsides or daily activities feel manageable. However, returning too early significantly increases the risk of reinjury. 

Considering the average physiotherapist treats 1-5 ACL injury patients per year, the high volume my team and I see gives us insights into rehabilitation, which I hope sets us apart. 

Embarking on my PhD thesis has given me immense knowledge and experience in treating hundreds of athletes after ACL injury.

Combining clinical and research knowledge is crucial, so what does the research tell us about rehabilitation?

We know participation in ACL rehabilitation is critical to facilitating a return to sport. 

However, growing evidence suggests that due to inadequacies in current rehabilitation programs, patients are returning to sport too early and with significant deficits in knee function, risking reinjury and long-term impairments.

This is highlighted by research demonstrating that only 5% of people complete evidence-based rehabilitation, including ≥6 months of rehabilitation, agility and landing exercises, and a structured return to sport.

As a result, patients do not meet discharge criteria before RTS, as even with well-controlled and implemented rehabilitation, only 10% of patients meet discharge criteria. 

It is now widely accepted that 9–12 months of rehabilitation is required for return to high-risk sport6.

It is not that patients don’t see a physio; it is that they drop out early (typically 4-6 months) and don’t complete the most critical phases of rehab to prepare for sport. 

Clinically, we see this all the time with the inability of patients to meet return-to-sport criteria and train at a high enough intensity to overcome the deficits from ACL reconstruction surgery.

Few people will do the required training, such as high-level jump and landing, plyometric training, supervised change and direction training. 

Few people will make a gradual return to sport and pass appropriate testing and physical benchmarking tests throughout the rehab process to return to sport safely and confidently.

It is the reason I started my PhD in the first place and led the formation of our Sports Knee Program. 

In the end, you can have a pristine knee with a perfectly reconstructed ACL, but if they have not physically prepared their knee for sport, then it is all worthless.

Don’t be one of those people.

Ensure that your rehab contains these 7 key elements: 

1. In Clinic Treatment: Techniques to alleviate discomfort and reduce inflammation, overcome difficulties and progress rehabilitation.
2. Functional assessments: A clear set of progression criteria for each phase determines if you are ready to progress to the next level of activity and eventually return to sport. 
3. Strength training: Gym-based exercises to rebuild quadriceps, hamstrings, and core muscles. This should progress from introductory strength exercises to heavy strength training. 
4. Jumping and landing drills: Training to improve technique, quickness and power. They also significantly reduce injury risk.
5. Running and agility exercises: Gradual reintroduction to dynamic movements with a focus on optimal technique. There is no point in being strong if you still move poorly. 
6. Conditioning: Building endurance for sports performance.
7. Sport-specific training: Gradual return to practice and competitive play.

Prematurely ending rehab after a few months can jeopardise your recovery. 

Our team is dedicated to keeping you on track, ensuring your knee is ready for the rigours of sports.

Steps to Take If You’re Considering ACL Surgery

If you suspect an ACL injury, here’s how to proceed:

1. Consult a physiotherapist: Get a comprehensive assessment and understanding of your treatment options with a physio specialist in knee injury management. You should also start pre-surgery exercises to reduce swelling and strengthen muscles, setting you up for a smoother recovery.
2. Meet with an orthopaedic surgeon: A specialist will evaluate your injury and discuss management options, including surgery options for an ACL reconstruction.
3. Commit to rehabilitation: Post-surgery rehabilitation may be more important than the surgery. Our Sports Knee Program may be an option for you. 

By working with both a surgeon and physiotherapist, you’ll have a comprehensive plan to return to the activities you love.

Wrapping Up

That’s the final edition in our 3-part series on ACL injury management. We have covered Cross Bracing, Rehabilitation without surgery and now ACL reconstruction. 

Overcoming an ACL injury with reconstruction surgery is a process that requires both expert surgical intervention and committed rehabilitation. 

Although surgery reestablishes knee stability, it’s the comprehensive, ongoing rehab program—including strength exercises, functional evaluations, and sport-specific training—that guarantees a secure return to your active life.

Yours in knee health,

Dr. Adam Walker
Gold Coast Knee Group

P.S. Discover how our Sports Knee Program can help you recover. Contact us at 0408 051 943 or email us to start your journey!