No matter how strong you are, no matter how many injury prevention programs you commit, an ACL rupture can still occur.
Once you get the MRI results, see your GP, specialist, physio and whoever else you need it can be overwhelming figuring out what you need to do, and the best course of action. Let’s start with the most obvious one
1. Surgery
This is the most obvious solution. See a knee surgeon, they book in a date, and you go in and get the surgery. They may take a few weeks to get you in, which will give you an opportunity to work on building up your strength. Research shows that the stronger you are going into an ACL operation, the better you will be after. There are a couple of options they may go through regarding where to get the graft for the ACL
a) Hamstring
b) Patella Tendon
c) Donor graft
d) LARS (synthetic tendon)
They each have their pro’s and cons, but generally speaking if it is your first ACL, they will opt for the hamstring tendon graft. Early surgery is generally the best option for those under the age of 25, playing high level pivoting sport, or have an unstable knee
The main con with surgery, are the usual ones associated with any surgery (risk of infection, reaction to the anaesthic etc). It is important to remember that when they take the hamstring graft, they are taking out a part of the hamstring tendon making it weaker. You would almost treat it like a hamstring tear.
So if you are someone who have had hamstring issue, electing for a different graft might be a better option.
2. Three- six months of rehab, followed by surgery
This option is becoming more and more popular. The idea here is that you spend three months building up your strength, even getting up to the point where you can jog at a good pace. The research shows that at this point, a lot of people may find that their body is strong enough to cope without an ACL, and they don’t surgery, or they will put it off for a number of years.
3. Conservative rehab
This option has gained more traction recently, and there have been a big push by physios to encourage people to avoid ACL surgery, or at the very least have a stab at conservative rehab.
There is lots of research to show that you can cope without an ACL, if your quad, hamstring, calf, glute, and core strength is good enough. Our clinic has seen a number of great outcomes with conservative rehab.
However, normally those who get this option are older, or have no intention of playing pivoting sport. They have a stable knee, with minimal or no meniscus damage.
The main con of this option is that if you do have a unstable knee, persisting with conservative rehab can damage the meniscus and make any future surgery more complicated.
No matter what option you take, you are looking at between 6- 12 months of rehab. ACL injuries are long, expensive, and mentally draining rehab to come back from, and being prepared is important.
If you missed part one and part two, check them out to learn more on how they occur, and what you can do to prevent them.
