Returning to football after ACL surgery

Returning to football after an injury and surgery takes time. Discover what to expect in the months following your ACL reconstruction with our recovery timeline and advice from two consultant orthopaedic surgeons.

Rupturing the anterior cruciate ligament (ACL) is a common injury among footballers at all levels. In fact, anterior cruciate ligament injuries account for 50% or more of all knee injuries.1

Although it can be a devastating injury for young athletes, it is possible to return to sport following ACL reconstruction surgery.2

The Consultant's View

Mr Bhupinder Mann from BMI The Chiltern and BMI The Shelburne Hospital shares his tips for recovering after ACL surgery.

8 tips to be aware of during your recovery

1. Get fit again

Do not underestimate the decline in fitness levels following an ACL injury. Cardio workouts on a stationary bike or even speed walking can be an excellent way to help regain fitness levels in the early stages of recovery.

2. Include your training routine in your everyday lifestyle

It’s important to try and fit your training routine into the normal plan for the day e.g. whilst at home watching television or spending time with family and friends.

3. Speak to your family and friends

It may be worth letting your family and friends know that a significant time (approx. 45 min a day) may be required to perform exercises as this may impact upon family life or social engagements.

4. Keep motivated

The recovery period can take up to one year - which is a long time. Training and recovery can be a dull experience, especially if you are at home alone during the initial stages of recovery. Developing and adhering to an exercise plan at home can be difficult, but one useful tip is to have an exercise chart. It may help to speak to your surgeon, physiotherapist or GP if you feel you are struggling.

5. Learn to use the hip to stabilise the knee

The hip is connected to the knee by the thigh bone. A strong hip will help to control the knee during turning, landing and planting your foot. It’s therefore important to work with your physiotherapist to activate and strengthen the hip and core muscles.

6. Regularly check in with your physiotherapist

Your physiotherapist will need to review your progress to check if you are ready to proceed to the next level. Each progression has a checkpoint e.g. prior to running you will need to demonstrate a stable single leg squat. However, we all progress at different speeds, do not worry or chase targets. Your physiotherapist will work with you on various movements. Each movement should begin slowly and carefully and only as confidence increases should you gently develop the speed and complexity of the movement.

7. The biggest challenge can be the “unknown”

Education is the key. The more you research and learn prior to the procedure the better. It’s important to fully engage with your surgeon and physiotherapist, as well as reading information leaflets and to keep asking questions.

8. Pain doesn’t always mean re-injury

During the recovery phase, pain does not necessarily mean re-injury. Pain can often be due to muscle inactivity or malfunction and can improve as physiotherapy progresses and muscle patterning improves.

To help manage your expectations during recovery, we’ve put together a post-surgery recovery timeline:

Immediately after ACL surgery

Your knee will be very swollen immediately after the operation. The first part of your rehabilitation will be to reduce the swelling as quickly as possible. This can be done with ice and compression, which can also help to manage the pain. You may also be advised to take painkillers, however your healthcare professional can advise further on this.3

Two to six weeks after surgery

During this time period, the swelling around your knee should have greatly reduced. However, the tissue graft inserted during your ACL reconstruction surgery is usually weak around this time meaning the ligament may only be able to handle very light therapeutic exercises such as, extending your knee and walking. You should be able to walk unassisted without crutches after two to three weeks.3

Six to twelve weeks after surgery

A few months on from your surgery your knee will be stronger and able to handle more pressure and more strenuous exercises. By this time you should have full range of movement. You may also be able to do non-weight bearing exercises such as swimming and cycling.4 This will enable you to build up the muscles in your knee without putting too much strain on the ACL. It will also help to counteract the loss of conditioning as a result of taking time away from regular training.

When can I return to football?

The point at which you are ready to return to playing football depends on the strength and stability of your knee.,

Your physio will want to make sure you don’t feel pain in your knee when you run and that there is no swelling. You will most likely be cleared to play when you have an acceptable range of motion with good stability, and when your injured knee is as strong as your other knee.

Three to six months after surgery

This phase of your recovery is about you getting back to full strength - the pace needs to be set by you. By this point your physiotherapy exercises should have improved the use of your knee with a good range of movement, but there may still be some pain that you need to manage.

Many footballers will feel able to return to running at this point, but your physiotherapist may want to make sure you pass further functional tests before giving you the go-ahead to run. It’s important to remember that everyone is different and full recovery can take up to a year.3

The Consultant's View

Mr Deepu Sethi, Consultant Orthopaedic and Knee Surgeon at BMI The London Independent Hospital offers advice around physiotherapy following ACL surgery.

Q: Is physiotherapy important to my recovery?

A good physiotherapy rehab program is just as important as having had a successful operation when it comes to ACL surgery. The emphasis is on the footballer taking an active part in the rehab program to ensure a safe and successful return to sport.

The risks of returning too soon

It’s important that you only return to sport when your body is completely ready. You could risk re-tearing your ACL if you demand too much of your knee before it’s ready. For many people there are risks involved in returning to football less than 12 months after surgery. The precise length of time it takes to recover varies between individuals and it’s important to make sure you feel ready to start playing again.

Our Sports Injury Clinics offer specialist services for amateur and professional athletes to diagnose, treat and rehabilitate a range of sports-related injuries, including ACL tears.

To find out more about how our Sports Injuries Clinics can help you, call us on 0808 101 0337 or make an online enquiry.


Sources
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867093//a>
2
https://bjsm.bmj.com/content/39/3/127
3 https://www.nhs.uk/conditions/knee-ligament-surgery/recovery/
4 https://www.ouh.nhs.uk/patient-guide/leaflets/files/121210acl.pdf

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