What to consider before your Anterior Cruciate Ligament (ACL) Surgery

This article was written by Darren Flannery, our knee physio expert. To Photo of Darren Flannery book an appointment with Darren, click here. 

Is surgery the best option for you? 

Some factors that might influence your decision on  whether surgery is the right choice for you:

  • Your age
  • Ongoing episodes of your knee giving way
  • Whether you had any other injuries with your ACL injury e.g. a meniscus tear
  • Plans to return to high level pivoting or contact sports or sports that involve jumping or landing

Ask yourself; What are my goals? Do I have all the information that I need? What are the risks vs rewards? Have I been given enough time to make a decision?

Gather your team

Your team can help guide you with your decisions, guide your rehab and keep you motivated. Choose a trusted surgeon, ideally someone who specialises or spends a significant amount of their time treating ACL’s. Talk to physios and others who have had their knee done and do your homework. Each surgeon will have a preference on what graft type to use and may not be the most sufficient for you given activity/work level and age.

What does rehabilitation after ACL surgery involve?

Start the rehab process even before surgery (prehab). The stronger you are going in and the better range of motion you have, the better the outcome post op is likely to be. Current guidelines recommend delaying the decision about surgery until you recover normal knee function. If wanting to return to multi directional/high-risk contact sports, you must be willing to commit to criteria-driven rehab over time-based rehab.

Criteria-based rehab will allow for all deficits commonly found post ACL surgery to be targeted. If you want to give yourself every chance of returning safely to sport while minimising the risk of re-injury, it’s recommended you go through a criteria-based rehab process. This process will involve several different variables that include strength, jumping and landing (plyometrics), balance and sport-specific drills. People with better functional performance on this criteria-based process, have lower chances of re-injury and better long-term outcomes, including lower rates of osteoarthritis.

It is recommended to wait at least 9 months before returning to sport. The longer you wait the lower the chances of re-injury. Always go on the guidance of a suitably qualified health professional.

Mental challenges of rehab process

One of the most common mental challenges is overcoming the mental fatigue that this rehab process is long term. A lot of the rehab will be done away from your teammates on your own in the gym. Often it will feel like you’re doing the same exercises for weeks on end and getting nowhere. Getting over the mental aspect of burn-out and boredom while trying to visualise the end goal is very important. Don’t lose hope! Every individual is different – recovery and healing rates will be different. Its important just to stay motivated and be patient.

You will feel ready to return to sports when you are ready!  

Gym access – it is recommended to have access to a gym-based environment to allow you to optimise strength gains while also being able to work on your jumping/landing techniques, balance activities and sport specific drills.

Time off work – depending on your occupation, time off work initially post op is recommended to allow time for pain and swelling to settle. Whilst this is happening it is also important to get full range of motion back and begin building strength.

Returning to driving is usually not recommended until at least 6 weeks post op – the goal is you must be able to perform an emergency stop pain-free.

If you would like some further advice to aid your decision process pre-op or to help your rehabilitation post-op, you can book an appointment with Darren here. 

ACL decision process