ACL Reconstruction Recovery? Can You Get Back to Sports after ACL Injury?

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acl reconstruction recovery

Most athletes and weekend warriors that tear their ACL believe that getting a new one is like getting a bad part replaced in their car. You go in for some surgery and after a while, you’re good as new. But is that really what ACL reconstruction recovery looks like? Not so much. Will you return to sports just like before? Some new research shows that the answer is a resounding “Maybe”.

The ACL

Before we can get into ACL reconstruction recovery, let’s quickly review ACL tears. The anterior cruciate ligament—the ACL you hear a lot about in sports—connects the femur to the tibia and is key to knee stabilization and function. It prevents the knee from going too far, from hyperextending, so you don’t kick yourself in the face or look like Gumby.

Found in the middle of the knee, the ACL is critical for quick movements, for cutting to the hoop on the basketball court or sidestepping the baseline in a tennis match. Tears in the ACL can be caused by contact—as with the great Denver Bronco running back Terrell Davis—or simply through an intense change of direction with no contact at all. Athletes often feel that scary “pop,” followed by intense pain and swelling.

Though the Medial Collateral Ligament (MCL) is the most common knee ligament injury, it often heals on its own (3)—while a significant ACL tear usually requires either precise injections of the patient’s own bone marrow cells or surgery (4-6). Though ACL Reconstruction surgery (ACLR) has been common since the polyester days of disco, the long-term consequences of returning to competitive sport (or dancing) remain inadequately studied.

The New Research

A recently-published study hopes to shed some long-term light on ACL reconstruction recovery and returning to play sports after ACLR (1). Of the 93% of participants who responded to a questionnaire, 83% returned to play pivoting sports after early ACLR, but only 53% attained a preinjury level of competition. Males and females return-rates were similar, but males had an average career of ten years after injury compared to four years for females.

Twenty-eight percent of those who returned to competition experienced contralateral ACL injuries against only 4% for those who did not return to play. The combined reinjury rate of both groups when returning to preinjury level of play was 41%.

As with Terrell Davis, the study showed that ACLR did not guarantee patients a return to the preinjury level at their chosen sports. The study concludes that those who return to pivoting sport competition after ACLR do so at high risk for contralateral ACL injury—noting that after routine follow-up has concluded, significant ACL reinjury can still occur.

Other Problems with ACL Reconstruction Recovery

These results are also mirrored by other studies. For example, a 2016 study of ACL reconstruction recovery following patients 5-20 years after injury found that 39% returned to play competitive sports, 28% returned at a lower level, and 32% did not return to sport (1). Also, many other studies have shown problems with ACL surgery:

Avoiding ACL Surgery?

Can you avoid ACL reconstruction recovery by skipping the surgery? In about 2/3rds of the cases, we can help the ACL tear heal in the knee by using a precise injection of the patient’s own stem cell rich bone marrow concentrate. This is a technically demanding procedure that uses real-time x-ray to confirm placement, but the results to date have been very good (4,5). Below is a video that reviews that procedure:

The upshot? The research shows that ACL reconstruction recovery isn’t what most people believe. As the studies show, about half of the patients or more won’t return at the same level of play or at all. So ACL surgery is just one way to try to fix the problem that has positives and negatives.

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References:

(1) Lindanger, L., Strand, T., Mølster, A. O., Solheim, E., & Inderhaug, E. (2019). Return to Play and Long-term Participation in Pivoting Sports After Anterior Cruciate Ligament Reconstruction. The American Journal of Sports Medicine47(14), 3339–3346. https://doi.org/10.1177/0363546519878159

(2) Filbay S, Ackerman I, Russell T, Crossley K. Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties. First published: 11 May 2016. https://doi.org/10.1111/sms.12698

(3) Andrews K, Lu A, Mckean L, Ebraheim N. Review: Medial collateral ligament injuries. J Orthop. 2017;14(4):550–554. Published 2017 Aug 15. doi: 10.1016/j.jor.2017.07.017

(4) Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;8:437–447. https://www.ncbi.nlm.nih.gov/pubmed/26261424

(5) Centeno C, Markle J, Dodson E, et al. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med. 2018;16(1):246. https://www.ncbi.nlm.nih.gov/pubmed/30176875

(6) Mahapatra P, Horriat S, Anand BS. Anterior cruciate ligament repair – past, present and future. J Exp Orthop. 2018;5(1):20. Published 2018 Jun 15. doi: 10.1186/s40634-018-0136-6

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8 thoughts on “ACL Reconstruction Recovery? Can You Get Back to Sports after ACL Injury?

  1. Frank C Romeo

    I fell of a mountain in Alaska, I had the ACL and MCL and the tendon attaching the Gluteus Maximus tendon to my leg treated by Dr. Movva in Dallas. 90% recovery, miraculous results. Stemcell and PRP treatment is by far superior to conventional surgery. Never thought I’d walk again without pain.

    1. Regenexx Team

      Hi Frank,
      Great to hear you’re doing so well!

  2. Sherry

    My daughter suffered a complete ACL tear when she was 15 and had reconstruction surgery. Fortunately, she had a great recovery and has gone on to become a collegiate track All American. My concern for her is the likelihood of arthritis. Can Regenexx provide any type of benefit for her this long after surgery, as a preventative to potential arthritis?

    1. Regenexx Team

      Hi Sherry,
      Unlikely, or at least that application of our technology is not tested.

  3. Nick

    Hi – In March of this year, I had the Regenexx stem cell injection in NJ for my full thickness ACL tear that I had injured in a ski accident last December. Nine months after the Regenexx treatment, I am doing great . . . I think. I played a bit of tennis, basketball and bowling the past couple of months – no issues. Still some slight discomfort when I’m doing squats, but not painful. The reason I wrote “I think” above is that Regenexx does not make it a practice to do a follow up MRI 6-9 months after the treatment. My insurance would “cover” it (I have a high deductible plan so I would be paying for it so insurance doesn’t really care). My question is why doesn’t Regenexx make it a standard practice to do a follow up MRI to confirm whether or not the treatment worked?

    There are quite a few before and after MRIs on the website showing that at least in those cases, there seems to be MRI confirmed healing of the ACL, but making the MRI follow up a standard practice, or at least an optional practice that the Regenexx doctor would write a prescription for and mention as an option, would be a lot more credible I think.

    1. Chris Centeno, MD Post author

      We do generally re-MRI ACLs, where were you treated?

  4. nick

    Hi – I had responded to Dr. Centeno’s question to me in the comments below that Dr. Kramberg in Wayne, NJ is where I was treated. Dr. Kramberg and his staff had indicated that another MRI is something that they usually don’t do for any patients, not just in my case. Any thoughts as to why the MRI is not recommended as the general practice for that Regenexx site? The sites should try to follow the same protocol.

    1. Chris Centeno, MD Post author

      If the focus of the treatment was ACL, then routine repeat MRI is recommended. If the focus of the treatment is arthritis, then it’s usually not.

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