ACL Tear Rehab: Duration of Recovery

Can ACL Rehab Be Accelerated for Athletes to Return to Sports?

ACL reconstruction surgery is a common treatment used for athletes who injure their anterior cruciate ligament (the ACL). The ACL is one of four major knee ligaments and is critical in contributing to the stability of the knee joint. Without a functioning ACL, the joint can be prone to the sensation of giving out. This instability of the knee can make participation in many sports difficult or impossible. For this reason, many athletes will choose to undergo ACL reconstruction surgery. Following surgery, there is a prolonged and intensive rehabilitation period necessary to restore normal knee function, strength, and stability.

meniscus repair rehab
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Standard ACL rehab takes 7 to 9 months to complete. For many athletes, not only does this mean the end of their athletic season, but it may interfere with their being ready for their next competitive season. But can ACL tear rehab be sped up? How long do you have to wait before returning to sports after ACL surgery?

Duration of ACL Rehab

The media is filled with reports of athletes who make a fast recovery and return to sports sooner than expected. Often you hear of famous athletes who undergo surgery and make a faster return to sports than initially anticipated. Does this mean that you can have a faster recovery after surgery for an ACL tear?

When you have ACL reconstruction, a new ligament is created and held in your knee with screws or other fixation devices. The ACL then has to heal in this position in order to withstand repetitive stresses associated with sports activities. The problem with any type of ACL graft fixation method is that, if repeatedly stressed before the graft has healed in position, the graft will eventually fail. That means the new ACL graft can become loose or re-torn.

Furthermore, there are other risks of overly accelerated rehabilitation. For example, former NFL wide receiver Jerry Rice famously made a comeback 3 ½ months after undergoing ACL reconstruction in 1997. In his first game back, he fractured his kneecap (where the ACL graft was taken from). This new injury ended his season.

Minimum Time for ACL Tear Rehabilitation

Exactly how long the ACL graft takes to heal sufficiently is open to debate. Furthermore, some sports and activities will place a higher demand on the ACL and more healing may be necessary prior to participation. Most orthopedic physicians agree that a minimum of 6 months is needed before returning to competitive sports. Because of potential risks of reinjury, however, most recommend waiting 9 months.

You should always discuss returning to sports with your surgeon, as there are variations to standard ACL rehabilitation. Variations in rehabilitation may be due to the type of graft used, any procedures performed along with the reconstruction (such as meniscus repairs or cartilage repairs), or surgeon preference.

Lastly, ACL rehabilitation is not only an issue of time. ACL rehabilitation involves a progression of therapeutic and sport-specific activities. In order to progress from one step of rehabilitation to the next, you must be able to complete certain activities. If a patient is unable to continue progression, overall rehabilitation may be delayed. Furthermore, optimized muscle balance and coordination can actually protect your ACL by minimizing the stress placed on it, once you return to playing sports. That is why working with a physical therapist is so important after ACL surgery.

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  1. American Academy of Orthopaedic Surgeons. OrthoInfo. Anterior Cruciate Ligament (ACL) Injuries.

  2. Bliss JP. Anterior cruciate ligament injury, reconstruction, and the optimization of outcome. Indian J Orthop. 2017;51(5):606-613. doi:10.4103/ortho.IJOrtho_237_17

  3. Beischer S, Gustavsson L, Senorski EH, et al. Young athletes who return to sport before 9 months after anterior cruciate ligament reconstruction have a rate of new injury 7 times that of those who delay return. J Orthop Sports Phys Ther. 2020;50(2):83-90. doi:10.2519/jospt.2020.9071

  4. Ajuied A, Smith C, Wong F, Hoskinson S, Back D, Davies A. A survey of rehabilitation regimens following isolated ACL reconstruction. JMED Research. 2014;2014(118077). doi:10.5171/2014.118077 

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