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The healing process of a torn ligament requires a blood supply to provide the elements needed for the repair. The blood supply to the ACL comes from a vascular synovial envelope which is supplied from the genicular artery, it wraps around the ACL. The small blood vessels from this envelope link to a network of small vessels within the ligament (). When the ACL is injured and torn this network of blood vessels is also damaged. Therefore, the blood supply will be compromised, the degree of which depends on the extent of the damage, and the healing will be impaired. , 1983
It is for this reason that in higher grade tears the blood supply will be assessed and surgery is often offered to an athletic population. This can be reconstructive or augmentation surgery, which will use a tissue graft most commonly from the hamstring tendon, and sometimes the patella tendon.
The recovery time with rehabilitation, and without surgery, can take weeks or months depending on the extent of the damage. A grade 1 typically will take 4-8 weeks, while a grade 2 tear will take about 3 months. The recovery of the ACL depends on several factors including the specific injury and extent of injury, the persons activity levels, their fitness levels and their general health. In most cases if the tear is assessed minor enough that there is potential for it to repair itself, then rehabilitation with an experienced physical therapist will be the treatment offered.
Surgery and the rehabilitation that follows, is a long process that takes about a year or more for most people. Some elite athletes are able to return after 9 months, but their rehabilitation is in general much more intensive as it is their job. Some people decide not to have surgery and can return to sports that don’t require sudden changes of direction, stop and starts, or pivoting. Therefore, if you want to get back to walking, straight line jogging, cycling or front crawl swimming, these are all possible without surgery.
Rehabilitation is still very much necessary even if you don’t have surgery. The injury and trauma will need recovery, there will typically be a loss of range of movement, pain and swelling that needs to be overcome and a reflex inhibition of the quadriceps that must be addressed to regain full function of your knee.
Taking the non-surgical route has its risks, however. There are long-term effects of recovery from an ACL tear without surgery. The knee will always be lacking the function of the ACL so the anterior movement of the tibia on the femur and rotation of the knee will always be more vulnerable, especially with high forces. This can mean that other structures are damaged such as the meniscus, or collateral ligaments. There can be a higher risk of re-injury to the ACL without surgery. The full impacts of choosing surgery or a non-surgical option should be discussed with your consultant and/or physical therapist.
Rehabilitation in the acute phase will focus on reducing swelling and pain, and regaining mobility. Once this is achieved, a gradual increase of strengthening exercises will be introduced. Strengthening is focused to the hamstrings as these can actively help to support the ACL’s function of preventing anterior movement of the tibia on the femur. As well as other muscles to improve knee strength and control such as the quadriceps, calf and glutes. You can read more about this in our related article: Exercises for ACL Recovery.
Prevention is better than cure, especially in the case of an ACL tear. The recovery of a tear is long and the knee may have other injuries along with the ligament tear. The rehabilitative exercises that can be done to help recovery are for the most part great exercises to do to prevent an ACL tear in the first place.
ACL tear prevention exercises include strengthening the hamstrings, quads, calf and glute muscles, and improving flexibility of the muscles around the knee. They can then become specific to the sports that you play. A skier will have different demands on their knee than a basketball player for example. Preparing your body for your specific sport is essential. This can be done by breaking down the activities and actions that are done in the sport and working on the individual elements.
For skiing this might be building quad strength specifically in a squat position, at different knee bends like those help when skiing. They might also need to work on stability and weight shifting in these squat positions by using unstable surfaces that can move left to right to mimic the movement of the ski. While for basketball, there might be more emphasis on jumping and landing control, with changes of direction, and sudden starts, stops and turns.
By gradually increasing the difficulty of the exercise challenges, you will build the specific ability to cope with those movements that you need for your sport.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.