Recovering from ACL Injury: Insights and Rehabilitation Tips

Right knee anterior cruciate ligament injury (Japan)

In early August this year, I fell while living in Japan.
Two hours after the fall, my right knee swelled, and I was unable to bend it, experiencing severe pain.
I sought medical attention that same day, and due to internal bleeding in the knee, the doctor drained approximately 150cc to 200cc (equivalent to four syringes).
An MRI was performed that day, and the doctor confirmed that there was no bone damage, diagnosing a partial tear of the anterior cruciate ligament (ACL).
Conservative treatment was recommended (surgery was not necessary), and the doctor stated that full recovery would take six to eight weeks.

In mid-August, I began wearing a knee brace (with metal supports on both sides) and started basic thigh muscle strength training at home.
By the end of September, I was able to walk normally (without crutches), but after walking for a while, I experienced pain in the muscles behind my knee, and I still had difficulty squatting (with some pain in the knee when squatting).
The instability when going down stairs has significantly improved.
However, I mentioned these issues during my follow-up appointment in early October, and the doctor began arranging rehabilitation, starting with deep heat therapy for eight minutes, followed by some thigh muscle strength training.
I will continue rehabilitation twice a week.
1.
Since two months have passed, how much longer should I expect to recover?
2.
I need to stand for long periods (over eight hours) for work.
I have rested for two months in August and September, and I need to return to work in October.
Is my current condition suitable for normal work?
3.
Does "full recovery" mean returning to the state before the injury, or does it simply refer to training the thigh muscles to stabilize the knee for normal use, while the tear still exists?
4.
For patients with a torn ACL who undergo conservative treatment, what is the average recovery period? Additionally, how long does rehabilitation (thigh muscle training) typically take?
5.
How long should I normally wear the knee brace (should I wear it while sleeping as well)?
6.
What are the effects of deep heat therapy during rehabilitation? Is it better to continue rehabilitation at the hospital, or should I do thigh muscle strength training at home?
Thank you, being abroad makes me feel a bit uneasy...

Sho, 20~29 year old female. Ask Date: 2017/10/10

Dr. Shi Guozheng reply Orthopedics

Typically, recovery takes about three months, and after that, one can return to work.
If the anterior cruciate ligament (ACL) is torn, rehabilitation will restore some function, but it may not be 100%.
Achieving 80-90% recovery is considered good, as it helps increase muscle strength.
The tear will still be present during the recovery period, which lasts three to six months.
After approximately three months of rehabilitation, if there is no significant instability, a brace may no longer be necessary, and it can be removed during sleep.
At home, one can focus on strength training independently.

Reply Date: 2017/10/10

More Info

Recovering from an ACL (anterior cruciate ligament) injury can be a challenging process, especially when it involves managing pain, regaining strength, and restoring function to the knee. Based on your description, it seems you have already made significant progress since your injury in early August. Here are some insights and rehabilitation tips to help you on your journey to recovery.

1. Timeline for Recovery
Typically, the recovery timeline for a partial ACL tear can vary widely among individuals. Since you have already been in rehabilitation for about two months, you can expect to continue improving over the next several weeks. Generally, it takes about 6 to 12 weeks for significant healing to occur, but full recovery can take up to 6 months or longer, depending on various factors such as your age, overall health, and adherence to rehabilitation protocols. Given that you are already walking without crutches, this is a positive sign, and you may continue to see improvements in your knee stability and strength.

2. Returning to Work
Considering your job requires you to stand for long periods (over eight hours), it is essential to listen to your body. If you can walk normally and your knee feels stable, you may be able to return to work. However, you should be cautious about overexerting yourself. Gradually increasing your activity level and taking breaks when needed can help manage any discomfort. If you experience significant pain or instability, it may be wise to consult your healthcare provider before resuming full work duties.

3. Understanding "Full Recovery"
"Full recovery" can mean different things depending on the context. In your case, it likely refers to regaining strength and stability in the knee to perform daily activities without pain or limitation. While you may not have a completely intact ACL, the goal is to strengthen the surrounding muscles (quadriceps and hamstrings) to compensate for the ligament's function. This means that while you may not have a fully healed ligament, you can still achieve a functional knee that allows you to engage in most activities.

4. Average Recovery Time for Conservative Treatment
For patients who undergo conservative treatment for ACL injuries, the average recovery time can range from 6 to 12 months. Rehabilitation typically includes physical therapy focused on strengthening the knee and improving range of motion. The duration of rehabilitation varies based on individual progress, but consistent therapy sessions (like the two times a week you mentioned) are crucial for optimal recovery.

5. Use of Assistive Devices
The duration for which you should wear the knee brace or assistive device depends on your comfort and the recommendations of your healthcare provider. Generally, it is advisable to wear the brace during activities that may put stress on the knee, but you may not need to wear it while sleeping unless instructed otherwise. As you gain strength and confidence in your knee, you can gradually reduce the use of the brace.

6. Benefits of Deep Heat Therapy
Deep heat therapy can help increase blood flow to the injured area, reduce muscle tension, and alleviate pain. It is beneficial during the rehabilitation process, especially when combined with strengthening exercises. While home exercises are essential, continuing with professional rehabilitation sessions can provide you with tailored guidance and support, ensuring you are performing exercises correctly and safely.

Conclusion
In summary, your recovery from an ACL injury will require patience and dedication to rehabilitation. Continue to engage in your prescribed exercises, listen to your body, and communicate with your healthcare provider about any concerns. As you progress, you will likely find that your knee becomes stronger and more stable, allowing you to return to your normal activities with confidence. Remember, recovery is a journey, and every small improvement is a step towards regaining full function.

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