ACL reconstruction – what’s the recovery time and am I covered?

Tearing an ACL (Anterior Cruciate Ligament) can be a long and challenging experience1 that can see you take anywhere from six to 12 months to return to full activity and sport. The good news is, you won't always need surgery - and we'll go into detail of the signs it may be necessary. If your knee is unstable, surgery is usually recommended. If your knee is stable, nonsurgical options may suffice.

Fortunately, these days the procedure is performed by keyhole surgery to minimise the surgical trauma1. Jakub from HBF Physio explains more - he also speaks from experience, having recovered from two of his own ACL surgeries.

What is an ACL?

There are four ligaments in the knee joint. These ligaments are structures that help to control movement in the joint and keep the knee stable.

The anterior cruciate ligament (ACL) is one of these ligaments and connects the thighbone (femur) to the shinbone (tibia).

“If an ACL is damaged, the knee often becomes unstable and can give way when loaded. Over time, this damage can affect other structures in the knee,” says Jakub.

How do I know if I need ACL reconstruction surgery?

You’ll need to get an assessment from a medical professional to understand when reconstruction may be required, but signs that a knee reconstruction may be necessary include:

• Instability
• Functional impairment/loss of motion
• Secondary damage to the internal structures
• Rapid swelling of the knee
• A ‘pop’ in the knee when the injury happens

According to Jakub, an MRI scan is the gold standard for ACL injury diagnosis. Research, however, shows that a history and physical examination done by an experienced health professional is just as accurate.

As a result, the Royal Australian College of General Practitioners recommends that an MRI is only needed when a diagnosis is still unclear after a history and physical examination, or to confirm a diagnosis that may change your treatment.

An empowering resource worth exploring lives on NPS Medicinewise, and may help you weigh up what is important to you when considering surgery. 

What does ACL surgery involve?

An ACL reconstruction is usually performed by keyhole surgery and generally takes between an hour and 90 minutes.¹

“A typical ACL repair is done by grafting tissue, from either the hamstring or patellar tendon, into an anatomically correct position within the knee,” explains Jakub.

“The torn ACL is removed, and the new tissue is grafted and fixed into place with special screws where it acts as a scaffold for new tissue growth and maturation. Over the next 12 months, the graft tissue slowly matures and strengthens.” says Jakub

What is the recovery time?

According to Jakub, your recovery time depends on how much your knee and other structures were damaged and/or repaired in the surgery, but here are some general things to expect.

• Patients usually stay in hospital overnight and go home on day two.
• You should be able to walk with crutches after a day or two, and you may need to wear a knee brace for the first few weeks.
• The acute pain and swelling typically clears in the first 4 to 6 weeks and the knee will then feel weak but mechanically normal.

“The most painful phase of recovery lasts 1 to 2 weeks, where pain control, swelling control and range of motion are the key goals.” Jakub adds

How can I recover well?

Surgery is generally very effective if patients follow some key steps and return to activity in the appropriate timeframes. From Jakub's experience, he says "12 months is widely accepted as a safe time to return to full contact, full-intensity sport."

Ways to recover well include:

• Keep moving - be sure to visit a medical professional for suitable rehabilitation exercises and programs.

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  Look after your mental health too - feeling down after surgery is common - Look after your mental health by talking to a professional such as a GP, counsellor, or psychologist. There are also support groups online, often you can find one locally on Facebook.

   

• Self-care - stay active and practice meditation for physical and mental health.²

• Sleep well - Avoid sleeping on your back with a pillow under your knee as this may cause further damage to the knee. Any other positions that are comfortable are fine.