ACL Recovery and Return to Sports

Anterior cruciate ligament (ACL) reconstruction has been shown to stabilize an injured knee so that a motivated athlete can eventually return to his or her chosen sport. It is important to note, however, that the graft used to replace and repair an ACL tear can be damaged again under the same conditions that led to the original injury.

Studies have shown an overall "re-tear" rate of 3 to 7 percent in all patients. Recent studies, however, have shown a significantly higher failure rate of 10 to 25 percent in elite, high-level athletes who are less than 25 years old. This would include high school, college and professional athletes and those who participate in club sports. Injury to the opposite ACL can occur in up to 10 percent of reconstructed athletes.

Re-injury is a devastating event. What can be done to prevent this?

Many factors are part of an ACL graft injury including:

  • Sex
  • Age
  • Activity level
  • Common biomechanical and neuromuscular factors

It is the last category in which physical therapy exercises have been demonstrated to reduce re-injury.

Studies using a large group of soccer players, including Italian semiprofessionals and premier women players in southern California, have shown up to an 88 percent reduction in ACL injuries in those who participate in a specific strengthening and neuromuscular training program.

After ACL surgery at Virginia Mason, your physical therapist will guide you through a similar graduated exercise program. The goal is to develop the strength and control that gives you the best chance of returning to your sport without re-injuring your reconstructed ACL or injuring your opposite knee.

It is critical that ACL reconstruction patients participate aggressively in their rehabilitation program. Your therapist will emphasize at each visit what you need to do to return to your level of play. It is expected that during your recovery, you will perform your exercise program every day. Otherwise, a return to your previous level of sports participation may not be possible.

After a four-month recovery period, we will test you to determine what strength and neuromuscular deficits you have. We will then devise for you an individual strengthening program with a goal of eliminating these defects. You will be tested again at six months. The decision about when you will be cleared to return to play will be based on this testing and how much you have recovered good control and function in your leg.

To schedule an appointment to speak with a sports medicine physician about ACL recovery and return to sports, call (206) 341-3000.

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