ACL Knee Reconstruction: Successful Return to Sport
1 Feb 2016
There’s a popular belief that once you’ve done your knee, you’ll never be as good again. In fact there’s a whole lot of negativity about the injury, surgery, and rehabilitation. You only need to read a few articles on the web and words like ‘devastating’ and ‘catastrophic’, and phrases such as ‘career ending’ and ‘an athlete’s worst nightmare’ are repeated over and over. Well, talking from experience, it’s not that bad.
First of all, let’s tackle how devastating an ACL injury and reconstruction really is. The initial injury usually hurts like nothing else, for a minute or two, and then the pain is gone (unless another structure is involved). Surgery now takes only an hour or so, and there are two small keyhole sized scars and one 5cm scar on the front of the knee. Things are a little uncomfortable for a week or so after the operation, but for most people they’ll be back to normal day-to-day activities at 3 weeks, in the gym at 6 weeks, running again at 10 weeks, and starting light change of direction sports at 4-5 months.
Many athletes can and do return to sports like football, basketball, and skiing at 6 months post op, and whilst some evidence exists that the graft hasn’t fully matured at this point other studies have shown that accelerated rehabilitation (19 weeks!) doesn’t cause an increase in joint laxity compared with a non-accelerated program (1). The bottom line is that if you want/have to be back to sport within 6 months – you can. Just make sure the surgeon and physio etc support this notion.
Let’s move onto the one about it being a career ending injury. A recent study published in the American Journal of Sports Medicine investigated the success of elite French alpine skiers after ACL reconstruction (2). The study included 239 male and 238 female skiers who competed on the French national ski team for at least 1 season between 1980 and 2013. Of the 477 skiers in the study, 148 sustained an ACL injury. Believe it or not, the ACL-injured group were more successful (FIS rankings and number of podium finishes) and had longer careers (by roughly 3 years) than non ACL injured skiers. In the ACL-group, 55 podiums were achieved before ACL rupture, 176 after.
Whilst I understand that there is a high drop out rate from sport after ACL reconstruction for the general population (3), the study into the elite French skiers supports my own experience; if you have the desire and drive to return to, or improve in your sport – you can.
Whilst I wouldn’t wish an ACL injury on anyone, a little bit of grit, determination, and luck should see people successfully get back to sport.
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Beynnon, B.D., Johnson, R.J., Naud, S., Fleming, B.C., Abate, J.A., Brattbakk, B. and Nichols, C.E., 2011. Accelerated Versus Nonaccelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction A Prospective, Randomized, Double-Blind Investigation Evaluating Knee Joint Laxity Using Roentgen Stereophotogrammetric Analysis. The American journal of sports medicine, 39(12), pp.2536-2548.
Haida, A., Coulmy, N., Dor, F., Antero-Jacquemin, J., Marc, A., Ledanois, T., Tourny, C., Rousseaux-Blanchi, M.P., Chambat, P., Sedeaud, A. and Toussaint, J.F., 2015. Return to Sport Among French Alpine Skiers After an Anterior Cruciate Ligament Rupture Results From 1980 to 2013. The American journal of sports medicine, p.0363546515612764.
Ardern, C.L., Webster, K.E., Taylor, N.F. and Feller, J.A., 2011. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. British journal of sports medicine, p.bjsports76364.
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