Anterior Cruciate Ligament (ACL) ruptures are one of the most common sporting knee injuries we treat at Trained Physio.  An ACL tear can have significant impact on the way your knee moves, with instability usually being the primary problem.   

Do I need surgery for a torn ACL? 

Previous theories favoured ACL reconstruction surgery due to a belief that it would prevent development of osteoarthritis in the knee and further damage to other structures. More recent research has debunked this, showing that an ACL knee reconstruction Perth does not show decreases in osteoarthritis at 20 years post-surgery and that osteoarthritis changes are 4-6 times more likely to occur in the 10 years following an ACL injury regardless of treatment choice. Additionally, there has even been research showing that a torn ACL can actually heal over time. 

Following a period of rehab with your qualified Trained Physio that involves strengthening, neuromuscular control, balance, and sport specific training, some people are able to recover from the initial injury and function normally without an ACL.  Other patients continue to have episodes of knee instability even after a period of rehab.  Those suffering from instability may be able to function in normal daily activities without an ACL, however if the goal is to return to high-demand sporting activities involving cutting, pivoting, and sudden turns an ACL reconstruction Perth may be necessary.  

Current clinical guidelines state that a period of rehabilitation should always be offered prior to surgical reconstruction.  This period can reduce ACL surgery by up to 50%, and after this, if someone is still struggling with instability then surgery remains an option, however with pre-hab already being completed you are in good stead for a successful recovery. 

How can I Prepare for ACL Surgery Perth? 

For those that do opt for surgery, pre-hab is one the most important things that you can do in preparation.   At Trained Physio we have a fully equipped rehab facility where we carry our in-house rehabilitation with our patients.  Many surgeons prefer to wait until swelling from the initial injury resolves to perform an ACL reconstruction and this can take several weeks.  This is an ideal time to prepare for surgery by building capacity of your muscles to minimize the effects of the injury, and prepare for post-op rehab.  Research has demonstrated a six-week pre-hab program results in better outcomes post-operatively.  

Most pre-hab protocols aim to eliminate swelling, regain full range of motion, normalise walking mechanics, and regain strength in the ACL deficient leg.  Patients lacking range of motion prior to surgery have greater difficultly restoring full range after surgery.  With this in mind, full knee motion should serve as a critical milestone prior to surgery.  Quadriceps strength is another key factor, patients showing strength deficits greater than 20% pre-operative (relative to the uninjured leg) had reduced strength at six and nine months post-operatively demonstrating that there must be a strong emphasis on strengthening the leg prior to surgery. 

 What is Involved in ACL Surgery Perth?

ACL reconstruction Perth involves removing the damaged ACL and replacing it with muscle tendon.  Tunnels are drilled in the shin and thigh bone and the graft is passed through these tunnels to “reconstruct” and secure the new ligament.  There are multiple different graft types, most commonly either hamstring tendon, patellar tendon, or donor tissue.  There is currently no scientific evidence pointing to one as superior as they all come with their pros and cons.  

Patellar Tendon Grafts – have bony attachment sites included in the graft allows for “bone-to-bone” healing which is often considered to be stronger, especially initially after surgery.  However, removing 1/3 of the patellar tendon for the graft does increase the risk of future patellar tendon problems.  Patellar tendon grafts are also commonly associated with pain in the front of the knee.  Patients may have complaints of this pain, especially when kneeling, even years after the surgery. 

Hamstring Tendon Grafts – have a smaller incision to obtain the graft and do not have the same bone removal as patellar tendon grafts.  As a result, the pain in the immediate post-op period as well as down the road tends to be lower.  However, the lack of bone-to-bone healing results in the graft needing a longer period of time to become rigid and therefore requires a longer protective period.  Additionally, removing a portion of the hamstring can result in a loss of flexibility bending the knee and reduced hamstring strength long term. 

Allograft or Donor Tissues – allows for a shorter operating time, no need to remove other tissue for the graft, smaller incisions and less post-operative pain.  However, these grafts have been shown to be weaker than if the patient had used their own tissue for it.  For many patients, the strength of an allograft is sufficient to meet day-to-day demands and therefore makes it an excellent option for those struggling with instability who are not planning to participate in high-demand sports. 

Recovering from ACL Reconstruction Surgery Perth 

Following surgery, the long road of recovery begins.  A progressive rehab plan allows the graft to slowly be worked into place within the knee.  In the first 2-4 weeks, the risk of the graft being pulled out of place is high due to the fact that the graft site has not fully healed. After about four weeks, the graft is more solidly in place, however, it is changing on a cellular level to become more like a ligament.  As a result of this, the graft is mechanically at its weakest around 6-12 weeks post-operatively.  Coincidentally, many people start feeling a lot better around this point and are keen to increase their exercise intensity, making this one of the highest risk times for re-rupture. There is a delicate balance between maintaining load in the knee and the muscles, but doing so without compromising graft integrity.

Current best practice in rehab suggests the use of criteria-based protocols, meaning that someone can only graduate through each level of therapy when they have hit certain milestones, rather than based on a strict schedule.  Regardless, the above shows that biological healing must be respected and as such a minimum of nine months is suggested before returning to sport.  Research shows that for every month that return to sport was delayed (up to nine months) there was a 51% reduction in injury.  

Returning to Sport following ACL Reconstruction Perth

Once you are out of the early protective phases of ACL rehab and have demonstrated sufficient healing, strength, balance, and control, your rehab must include sport specific drills.  ACL rehab must be highly individualised to address the specific needs of the activity that you intend to return to – it is not enough to just have a strong and stable knee at the end of rehab.  You need to feel confident and mentally ready to return and this only comes from drilling specific movements.  

Common return to sport criteria include: 

• Strength within 10% of other leg
• Hop tests within 10% of other leg
• Confidence running, jumping, and cutting at full speed (as well as with other sport specific movements)
• No functional complaints

 A 2016 study used these criteria to assess the outcomes of competitive athletes post ACL Reconstruction and they found the following: 

• 38% of athletes who returned to sports despite not meeting the criteria re-injured their ACL
• Of the players who re-injured their ACL, 39% of them did so earlier than nine months
• 100% of the athletes who tried to return in under five months (against medical advice) re-injured their ACL within two months  
• Only 5% of athletes who met all criteria re-injured their ACL

How Trained Physio can Help

Trained Physio allows you to improve your body’s capacity to endure higher training and competitive loads as well as improve several markers of running performance.  With stronger muscles, connective tissues, joints and more resilience to fatigue, you can spend more time on the road doing what you love and less time dealing with injuries.  At Trained Physio Perth we have a special interest in ACL Reconstructions with Andrew and Cameron both having ACL surgeries.  Not only do our Physio Perth have an eye for diagnosing and treating sport specific injuries, but we have a fully-equipped 24/7 gym to utilise for rehabilitation, injury prevention, and general strength & conditioning.

What you can expect from Trained Physio:

1. Thorough assessment and treatment of your injury
2. Comprehensive exercise rehab from the date of your injury, through to your return to full activity
3. Assessment into why the injury occurred in the first place, and what can be done to keep you injury-free
4. Manual therapy, dry needling and other treatment-specific techniques as needed
5. Training modifications to keep you as active as possible whilst undergoing rehab (if necessary)
6. Use of our fully equipped rehabilitation facility for exercise rehab

Conclusions 

• For those that do get surgery, a minimum of nine months and successful completion of return to sport testing is associated with the lowest risk of re-injury 
• Recovery from an ACL injury needs to be highly individualised
• A period of rehab should always be done after an ACL injury.
• ACL Reconstructions is indicated for those who want to return to high-risk activities but still struggle with functional instability after a period of supervised rehab

East Perth Trained Physio

East Perth Physio has several goals including promote healing, reduce pain, avoiding aggravation, optimising physical function and global strengthening to restore normal movement patterns.  To see how we can help you  BOOK ONLINE TODAY