15/06/2021
ACL surgery…When to operate?
Not all ACL ruptures will require surgery. Patients (particularly younger patients) who intend to return to active pivoting sports such as netball, basketball and football will benefit from an ACL reconstruction as they are likely to experience ongoing instability, with further knee injury episodes causing progressive symptoms and damage. Patients that experience instability during activities of daily living, despite appropriate rehabilitation, would also benefit from a surgical reconstruction.
Patients are encouraged to commence physiotherapy as soon as possible post injury/pre-operatively, as comfort allows, to maintain their quadriceps and hamstring strength as well as range of motion, and are advised to re commence formal physiotherapy 2 weeks post operatively.
The procedure itself takes around 90 minutes. Recovery is reasonably rapid with near-normal walking by approximately 2 weeks. If an associated meniscal tear is repaired, a knee brace may be required for up to 6 weeks, otherwise a knee brace is not usually necessary. It is normally 3 months before I encourage returning to straight line running. It is 12 months post-surgery before pivoting sports are allowed, as it takes this length of time for the graft to reach maximal strength. Patients are counselled that their graft will weaken due to tissue remodelling for the first 3 months post-surgery, with a slow increase in strength thereafter.
When not to operate?
I advise against ACL reconstruction for patients who are not participating in active sports and who are able to complete their activities of daily living without instability.
