The ACL (Anterior Cruciate Ligament) is one of four crucial ligaments that provide strength and stability to the knee. The others are the PCL (Posterior Cruciate Ligament), MCL (Medial Collateral Ligament), and LCL (Lateral Collateral Ligament). The MCL and LCL are on the inner and outer sides of the knee and run vertically whereas the ACL and PCL cross beneath the kneecap from top to bottom.
The ACL and PCL have a very poor blood supply which means that reconstructive surgery is usually required and a graft used to replace a torn ACL/PCL. Indeed, as the PCL is much stronger than the ACL, it is the ACL that is most often torn (200,000 cases per annum in the US alone) and it is the ACL injury that is, therefore, such a debilitating injury.
This article provides 5 key tips for rapid recovery from ACL injury. These are from my own personal experience. I quickly recovered from a full house of complete ACL, MCL and LCL tears, and I have documented what I believe to be the key factors associated with that rapid recovery.
In terms of ACL recovery secrets, the single most important factor for a quick recovery – a factor that improves the recovery time by a factor of 2 or greater – is the type of graft chosen. Of course, you should consult with your surgeon on what is best for you and, if you’re a professional athlete, my recommendation is not likely to be the best choice. However, for the rest of us casual athletes, this recommendation will see you recover way quicker than any other.
Grafts tend to be of the following three types:
- Patellar tendon – a piece of your own tendon is taken and used to replace the ACL. It matches tissue well and allows bone to bone healing which is strong but this can lead to anterior knee pain for years to come.
- Hamstring tendon – two tendons are taken from the hamstring and bound together and used as the graft. Healing can take longer because there is no bone to bone healing but this graft alleviates anterior knee pain.
- Cadaver – donor tissue. This has the advantage of requiring less operation time, being less painful and allowing for smaller incisions. The focus is on one area only and is much less disruptive as there is no secondary operation to remove the graft from the patella or hamstring. The disadvantage of a cadaver graft is that it is not as strong as the other graft types.
I had ACL surgery on day 34 after incurring my injury. Four days later I was off painkillers, was not using crutches or my knee brace and was starting post surgery physical therapy. I had a cadaver graft. This contrasted with other people I know who had grafts taken from their own bodies and were largely incapacitated for two weeks post-surgery.
So for non-professional athletes my number one tip for a quick recovery from ACL surgery would be to take a cadaver graft.
Use RICE techniques (rest, ice, compression, elevation) immediately post-injury, up to surgery and then afterward. This is somewhat obvious but, for rapid ACL recovery, take it to extremes. For example, in my case, the discipline that helped me enormously with my leg inflammation was passing up on situations where I would have to sit with my leg hanging down. I was lucky in that I work in an office and was always able to sit with my leg supported by another chair, but dining out, eating at the dining table at home were all passed up in favor of sitting with my leg up on the sofa.
Also, icing and compression can be accelerated and accentuated with an ice/compression cuff system such as the Aircast Cryo/Cuff Cooler.
Pre-surgery knee strengthening. Keep the leg and knee moving before surgery. Establishing a good range of motion (120 degrees of knee bend) ahead of surgery will help with the healing process post surgery. Ankle pumps help reduce calf muscle atrophy (wasting) where quad sets are essential to minimize quadriceps atrophy.
Walking is good and can be enabled by an ACL brace such as the DonJoy TROM Adjuster Knee Brace. This not only gives you a degree of normality and independence but it also means your calf muscle will work which will reduce atrophy and control swelling. In my case, use of this brace also meant I could drive again 8 days after injury – admittedly I drive an automatic.
Stay ahead of the pain curve. Anyone suffering an ACL injury will be prescribed strong painkillers both immediately after injury and then again after surgery. It is really important that they are taken as prescribed, including during the night. I set the alarm during the night to ensure I did not miss taking the painkillers. This is essential because if the pain gets you it can be very difficult to get rid of and, more importantly, you won’t want to move and moving is critical to rapid recovery.
Post-surgery knee strengthening exercises. As soon as possible post-surgery, begin the exercise regime that will re-build strength and stability, reduce inflammation, and increase range of motion.
Use of a stationary bicycle is extremely important to keep the knee moving. Twice a day, even if just rocking on the pedals in the first few days, was the frequency that saw me make such a paid recovery.