What does the ACL do?

To start with, those who do not know what the ACL does, it is one of the most important ligaments of the knee and is responsible for stopping the tibia (your shin bone) from moving forward in front of your femur (your thigh bone). Without it, there is potentially a large amount of instability that can occur.  When this happens there are two possible options, surgery or conservative care.  There is a growing body of research that is beginning to show that ACL’s can heal without surgery, leaving a very topical question right now of ‘how important is it to get surgery and could we actually have better outcomes without it’?  This trail of thought stems from a study that showed those who undergo ANY type of surgical intervention in the knee have an increased risk of knee OA in later stages of life.  What we do not yet know is whether it is the surgery that creates the risk or whether it is the injury itself.  See the graph below to see the risk increase for each injury.

How do I treat an ACL injury and the process?

But if we focus on the actual rehabilitation, what are the key markers we look for?  Well the first is to get the swelling, pain and ROM restored to ‘normal’.  This is vital in the early stages.  Once we have controlled this we begin with restoring neuromuscular function.  This is such a crucial stage of the rehabilitation process as it sets the tone for what comes after.  This stage can take around 3 months minimum but will always be a key feature of your rehabilitation programme.

Return to sport is always a question we get asked and the answer is always easy.  When you can pass a set criteria of tests we will pass you to return to sport.  The tests performed are undertaken regularly and happen on an almost weekly basis in some cases (especially in the early stages).  As you progress through the various stages they become more challenging but this is key in determining your readiness to return to sport.  One of the key things to obtaining these test markers is access to a gym environment.  In order to pass these tests, the body needs to be able to exert over 1.5 times its current weight into certain tasks.  It is very difficult to achieve this without regular strength training with load.

Once you have passed the various tests you can then begin to look at a return to training programme.  This is a difficult part of the rehab as sometimes it is where patients can mis-manage loads but we do our best to stay in regular contact with our patients to ensure that this does not happen.

Recently I had a patient of 24 years old with an ACL tear and I was fortunate to have seen him from the very early stages of his injury.  Initially I had contact with his surgeon to find out all the relevant information needed to plan his programme.  It is vital that the plan is adapted to the graft type (hamstring, patella or allograft).  This can determine the rate of healing and also where the possible areas of weakness are at.  We decided to see each other once per week which allowed us to track and record all his progress.  Whilst not at the clinic he had a full rehab programme to be working on each week.

After completing his gym programme we decided to attend a nearby park where we were able to set up a series of tasks for him to complete which tested his ability to return to play.  It is this level of rehab that often gets missed but we are fortunate enough to be able to offer this here at Bodylogics.

So if you, or anyone you know is looking to take their rehab to the next level for an ACL injury then we are on hand to help out and can steer you in the right direction to a full and happy return to sport.