There’s a push right now in ACL surgery return to sports to shorten the time actually needed for recovery. For some surgeons, this means telling patients that they can return to sports by 6-8 months. Now a new study questions the wisdom of those recommendations.
First, the ACL is a main stabilizing ligament of the knee. When it gets torn, the patient often hears a pop and a later MRI shows a “blown out” ACL. Surgical reconstruction of the ligament is one answer, although ACL re-tear rates are high and many athletes after ACL surgery never return to back to their previous level of play. Another huge issue with the surgery is that athletes are often told that they’ve lost a year of sports. To offer athletes hope of a quicker recovery, many surgeons have begun shortening return to play times, often clearing athletes to return to sports at the 6-8 month range. However, there’s limited information on whether this is a smart strategy or a disaster waiting to happen.
The new study looked at 69 patients with ACL reconstruction who performed a standardized test battery of one – and two-legged stability tests, counter movement jumps, speedy jumps, plyometric jumps and a quick feet test. The first test battery was given just shy of 6 months post surgery and the second at about 8 months. After these tests, only 15.9 and 17.4 % of the patients respectively met the criteria for a “return to non-competitive sports”. The most limiting factor was an inability to hop symmetrically with the operated leg performing like the normal one (LSI).
The upshot? The push toward getting athletes back to sport quicker after ACL surgery isn’t supported by this study. Less than 1 in 5 patients was ready to return to even non-competitive sports by 6 and 8 months after surgery! In the end, this is bad news for athletes choosing this invasive surgery. Why is it taking to long to be safe to return to sports? After this big surgery there’s significant atrophy in the leg and the “new” ACL doesn’t have any ability to feel where the knee is in space (proprioception). We’ve had good results in getting patients back to sports more quickly through using an injection of their own stem cells to try and heal the ACL ligament, which means less down-time, less atrophy, and an ACL ligament that still has proprioception!