I Tore My ACL… Now What!??
Chris Judd
ACL Injury 06/06/2015
So you’ve suffered a knee injury, you suspect you may have torn your ACL (or you may already know), what do you do next?
First of all, learning about what the ACL is, and what it does is a good place to start. Your ACL (Anterior cruciate ligament) is a connective tissue inside the knee which helps to stabilise the knee. What is very important to understand is that the ACL is not the only stabilising structure, and rather that it is part of a complex system of structures involving various connective tissues and muscles which can adapt and compensate.
Secondly, DON’T PANIC! Whilst it can be a very painful and scary injury, it is not life threatening, you can recovery, and you don’t need emergency surgery. Unfortunately, ACL injuries are often portrayed as “devastating and catastrophic” leading to fear mongering and rushed decisions.
Take your time, even if you have an important event you “urgently” need to get back to, in the scheme of things, you’re better off collecting your thoughts, letting your knee calm down, and doing some quality rehabilitation before considering any need for an op. Early surgery doesn’t lead to better results, and in fact it may cause poorer long-term outcomes, and a greater risk of graft failure leading to revision surgery (Filbay, 2017; Rahardja 2020).
Don’t rush to get an image. While it may seem like knowing exactly what “damage” is in your knee, Magnetic Resonance Imaging (MRI) often doesn’t change the course of management, and clinical history and tests are equally accurate in diagnosing an ACL injury.
Furthermore, imaging can be expensive, often generates fear regarding the extent of injuries despite very poor correlation to actual function, and increases the chance of having surgery irrespective of the actual clinical injury itself.
What you should do instead, is consult an experienced physiotherapist for a clinical and functional assessment, formalise a treatment plan, and begin a structured, comprehensive rehabilitation program.
Do some research. You’ll soon realise there is a good chance of recovery without needing surgery is pretty good. Between 50-77% of individuals may be able to recovery without surgery, provided they perform a structured rehabilitation program (Dhillon, 2014).
Evidence also shows, the better educated you are, the more you believe you can recover, and the less fearful you are of movement and exercise, the better outcomes you will have.
Believe in the process!! While things can seem slow and up and down, that is normal. Recovery is a rollercoaster and almost everyone believes they will recover faster than anyone else.
There is level 1 evidence that proves with a constructive, challenging, and progressive rehabilitation, it is possible to recover to pre-injury capacity, perform high level pivoting sports such as football, AFL, NFL, Basketball, Skiing etc. even at elite level without a functioning ACL. Remember how I said the ACL is just a part of a complex system. Well that system is excellent at adapting and stabilising the knee when it’s been trained to do so.
And finally… DO WORK!.. and also take the time to rest.
The more effort you put into recovery, the more you will get out. Although it seems like a long time, it’s fatiguing, and mentally challenging. It’s a small price to pay to ensure you can live the rest of your life without disfunction or pain. However, it is also equally important to actively recover. Burnout is real, and ensuring you schedule rest weeks (usually every 6-8) prevents burnout and allows you do put in the work when it really matters.
References:
https://bjsm.bmj.com/content/51/22/1622
https://www.sciencedirect.com/science/article/abs/pii/S096801601930314X
https://www.ncbi.nlm.nih.gov/pubmed/26401236
