ACL Injury Recovery: Timing and Rehabilitation Insights

Issues Before Reconstruction After Complete Tear of the Anterior Cruciate Ligament (ACL)

Dr.
Luo: After our last consultation, I waited five days to review the results of the MRI.
The doctor at the medical center informed me that there is a bone contusion, the medial and lateral collateral ligaments are lax, the anterior cruciate ligament is completely torn, and the meniscus is intact.
He mentioned that the internal angle of my foot is insufficient (about 95°) and advised me to undergo rehabilitation at a physical therapy center until both legs are comparable.
Initially, he recommended rehabilitation for two weeks before performing anterior cruciate ligament reconstruction surgery.
However, after a week, I returned to the clinic and informed him that I had an obligation two weeks later, so he suggested postponing the surgery for another week, totaling three weeks, and mentioned that I could stop relying on crutches.
By then, my angle had improved beyond 95°.
In the following three weeks, I visited him again, and the internal angle of both legs was close (about 120°).
I inquired if I could proceed with the surgery, but he indicated that the extension of my left leg was still inadequate and advised me to strengthen my rehabilitation.
We scheduled the surgery for a few days after four weeks.
Currently, my walking condition is nearly normal, but I have a question.
You previously mentioned that surgery could be performed about 2-3 weeks after the acute phase, but my doctor insisted on rehabilitation until both legs were comparable, which took about five weeks, plus an additional two weeks for the MRI.
It has now been over seven weeks since my injury, so I would like to ask: Is it indeed due to my limited range of motion that I needed such an extended period of rehabilitation to bring the injured leg closer to the normal leg? Or could there be other reasons?

Songhua, 30~39 year old female. Ask Date: 2002/03/26

Dr. Luo Zhaozhong reply Orthopedics

Basically, after the acute phase, both reconstructive surgery and waiting for more complete rehabilitation before surgery are options that people take, each with its own advantages and disadvantages.
For instance, when performing knee arthroplasty, we sometimes ask patients to first train their knee joint movements, as this can make future rehabilitation easier, but it does require some time upfront.
Some patients cannot wait, as in your treatment process; if reconstruction surgery is performed immediately after the acute phase, the rehabilitation process may be more challenging.
If rehabilitation is done first, it can help strengthen the muscles around the knee joint, making future rehabilitation less strenuous and more manageable.
Of course, sometimes we must also consider the patient's convenience, such as if the timing is not suitable or if there are other matters to attend to.
Generally speaking, for strong individuals with robust muscles around the knee, such as athletes, there is a tendency to address the issue sooner because they have a greater desire to return to the field quickly.
For the average person, the demands are not as strict, and even some individuals who rely less on their knees, such as older adults, may find conservative rehabilitation treatment acceptable.
I hope you can resolve your knee issues soon, and I wish you a speedy recovery.

Reply Date: 2002/03/26

More Info

Understanding ACL Injury Recovery: Timing and Rehabilitation Insights
Recovering from an anterior cruciate ligament (ACL) injury can be a complex and multifaceted process, particularly when accompanied by other injuries such as collateral ligament sprains or bone bruises. Your situation, where you experienced a complete ACL tear and associated injuries, necessitates a careful and structured rehabilitation approach to ensure optimal recovery and return to function.

The timeline for surgery and rehabilitation can vary significantly based on individual circumstances, including the severity of the injury, the presence of other injuries, and the patient's overall health and activity level. In your case, the decision to delay surgery until your knee's range of motion (ROM) improved to a more symmetrical level with the uninjured knee is a common practice. This approach is based on the understanding that achieving adequate ROM and strength prior to surgery can lead to better postoperative outcomes.

Typically, the acute phase of recovery lasts about 2-3 weeks post-injury, during which the focus is on reducing swelling, managing pain, and beginning gentle range of motion exercises. However, if there are significant limitations in ROM, as you experienced with your knee flexion being around 95 degrees, it may be necessary to extend this phase to allow for additional rehabilitation. The goal is to ensure that the knee is in the best possible condition before undergoing surgical intervention.

Your physician's recommendation to continue rehabilitation until your knee flexion reaches a more comparable angle to the uninjured knee (around 120 degrees) is a prudent strategy. This not only prepares your knee for the stress of surgery but also helps in establishing a stronger foundation for post-surgical rehabilitation. The rationale behind this approach is that improved preoperative function can lead to enhanced postoperative recovery, reducing the risk of complications and improving overall outcomes.

In terms of rehabilitation, it is essential to focus on both flexibility and strength. Physical therapy should include exercises that promote knee flexion and extension, as well as strengthening exercises for the quadriceps, hamstrings, and surrounding musculature. Modalities such as ice, electrical stimulation, and ultrasound may also be beneficial in managing pain and swelling during this phase.

Post-surgery, the rehabilitation process will typically involve a structured program that gradually increases in intensity and complexity. Early postoperative rehabilitation focuses on regaining range of motion and reducing swelling, while later stages will emphasize strength training, proprioception, and functional activities to prepare you for a return to sports or daily activities.

It is understandable to feel anxious about the timeline and your recovery progress, especially when you notice differences in your walking pattern. However, it is crucial to trust the process and adhere to your rehabilitation program. Each individual's recovery timeline can differ, and factors such as age, overall health, and commitment to rehabilitation play significant roles in recovery speed and success.

In conclusion, the extended rehabilitation period before your ACL surgery is likely a necessary step to ensure that your knee is adequately prepared for the procedure. Continue to work closely with your physical therapist and orthopedic surgeon, and communicate any concerns you may have about your progress. With dedication to your rehabilitation, you can expect to regain function and return to your desired activities in due time.

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