The benefits of a high-quality individualised rehabilitation program after having ACL surgery are clear, but what should individuals be doing immediately after their ACL injury? Well, current best practice guidelines1 advise gentle pain-free range of motion exercises within the first few days, followed by commencement of early ACL physiotherapy. The physiotherapist will take some measurements of swelling and range of movement as well as strength on the un-injured side. Early goals of physio are to reduce pain and swelling and restore normal range of movement. Following a significant knee injury it is common to experience poor activation and wasting of the muscles in the thigh, particularly the quadriceps. A large component of physio following knee injury is to get these muscles firing again and rebuild strength back up towards normal.
Together with an orthopaedic surgeon or sports physician, the physiotherapist can help guide the decision when to have the ACL reconstructed. It is generally accepted that patients should have their ACL reconstructed as soon as possible following injury. However, if the knee is still significantly swollen, painful and has poor function, it is likely to be in a worse state following surgery and take longer to return to normal. Ideally, before having surgery, the knee should have minimal swelling, good range of movement, muscle strength and balance. Studies have identified that pre-operative quads strength predicts outcome 2 years after surgery. This means that if someone doesn’t regain good quads strength before surgery, they have to work very hard for a longer time after surgery to get their strength back.
Depending on the type of injury, how an athlete is progressing with their rehab, and their sporting or functional goals, surgical intervention might not be necessary at this point. Regardless of whether an individual has surgery – undergoing a physiotherapist guided rehabilitation program immediately following ACL injury has been found to improve outcomes both pre- and post- surgery3.
One study found 50% of patients who delayed their operation and underwent rehabilitation avoided the need for surgery at all. Interestingly, over the following 6 years there was no negative consequences of delaying surgery. In fact, early surgery, and delayed (optional) surgical groups had no significant difference in the following outcomes:
- Participation in sport
- Quality of life scores
- Evidence of arthritis on scans
- Future surgery
If you’re interested in finding out more about ACL rehabilitation or seeking guidance regarding the best time to have your ACL reconstructed, contact us on 49216879.
- https://bestpractice.bmj.com/topics/en-gb/589/management-approach BMJ Best practice guidelines
- https://www.bmj.com/content/bmj/346/bmj.f232.full.pdf 2013 Study
- https://www.ncbi.nlm.nih.gov/pubmed/26879746 2017 Systematic review