When ACL reconstruction is performed too soon, patients are far less likely to return to competitive sport and are at significantly greater risk for anterior knee pain, arthrofibrosis and persistent weakness (1,2). “Appropriate timing of surgery is important for a full recovery after ACL reconstruction,” says K. Donald Shelbourne, MD, orthopedic surgeon at Shelbourne Knee Center. Full recovery—knee symmetry and the ability to return to competitive sport—is the goal for every patient at Shelbourne Knee Center.
Two variables are critical in deciding when to perform ACL reconstruction:
- Preparation of the injured knee
- The patient’s psychological readiness
Orthopedic surgeons at Shelbourne Knee Center delay surgery until both the knee and the patient are ready. Usually, this is about 2-4 weeks after the injury.
Preparing the Knee
Patients complete a research-based pre-operative rehabilitation (pre-op rehab) program to restore the injured knee to as close to a normal state as possible before ACL reconstruction:
- Full range of motion (ROM)
- Little or no swelling
- Normal walking
- Appropriate strength and leg control
Speeding Recovery
Achieving full ROM and returning the knee to a normal state (except for the ACL tear) speeds up recovery time and allow patients to more easily achieve their goals, according to research conducted at Shelbourne Knee Center (3). That’s why:
- 98% of our patients achieve full symmetric ROM (4)
- 85-90% of our patients return to sport at the same level within a year, compared to a 50–60% average for most orthopedic practices (4).
“What we’re doing gives our patients the best chance of having a good outcome, based on our data and research,” says Dr. Shelbourne.
Accepting the Road Ahead
Lack of psychological readiness to fully participate in rehab contributes to ROM issues post-op (1) and increased pain. “Patients are almost always angry when they have an ACL tear. Most are competitive athletes who are worried about getting back to sport at the same level. Some worry about making a college team or their scholarships,” says Dr. Shelbourne.
After anger comes depression, and, finally, acceptance of the need for surgery and rehab. “The best time to operate is when the patient has accepted it and has a positive attitude about recovery,” says Dr. Shelbourne.
Shelbourne Knee Center facilitates psychological readiness through:
- Pre-op rehab
- Education about what to expect
- Data on the practice’s results
Pre-op rehab helps patients get into the routine of doing rehab, and familiarizes them with many of the exercises they’ll be doing after surgery. Each patient has a personal physical therapist or athletic trainer who serves as a guide and coach through the entire process. Both the orthopedic surgeon and the physical therapist or athletic trainer teach the patient about his or her role in a good outcome.
Shelbourne Knee Centers’ high return to sport rate and other research data also help injured athletes move toward acceptance of the road ahead and a positive attitude about rehab. Pre-surgical patients usually have a chance to talk with athletes in the clinic who’ve already had ACL surgery.
Accommodating Life
Surgery also can be delayed after completion of pre-op rehab to minimize time away from school or work and to ensure that a caregiver can be present for the first week after surgery. For high-school athletes, surgery is often scheduled around the Thanksgiving, Christmas or spring breaks.
For more information about ACL reconstruction, call 888-FIX-KNEE.
References
- Haro MS, Shelbourne DK. Prevention and Management of Loss of Motion in Anterior Cruciate Ligament Surgery. Oper Techn Sports Med. March 2016; 24(1): 45-54. https://www.sciencedirect.com/science/article/pii/S1060187215001148
- Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991 Jul-Aug; 19(4):332-6.
- Biggs A, et al. Rehabilitation for patients following ACL reconstruction: A knee symmetry model. North Am J Sports Phys Ther. 2009;4:2-12.
- Unpublished data, 2018.