Many athletic people and professional athletes sustain a painful injury to the Anterior Cruciate Ligament of their knee and have several options for rehabilitation including surgery choices. If the patient is not intending to return to athletics and wants to commit to physical therapy options and doesn’t want surgery, it is possible to regain use of the knee again for normal living. However, the majority of patients want full use of their knee to return, will not consider a life without action and sports and therefore choose surgical repair. The most common sports to cause ACL injuries are: Soccer 23.5%, skating 13.7% and basketball and football both at 11.8%.
There are three primary choices of grafts for ACL surgeries: patellar grafts, hamstring grafts, and allografts (cadaver grafts). There is much speculation and debate about which graft and fixation is the best. Surveys show that the hamstring graft is the most popular choice currently for most people, but that the most serious athletes in competitive sports still choose patellar grafts, known for being the strongest, most reliable graft, but not necessarily the most pain-free.
The best advice before surgery is to wait at least six months to allow the swelling to abate, with full range of motion to return and pre-surgical strengthening exercises preparing the way. After surgery, the need to work with a physical therapist and/or athletic trainer is crucial. It will also take a full year for the proprioception to return which is the balance and agility factor, so important to keep from re-injuring the knee.
Out of 400,000 ACL surgeries a year, about 18,000 to 35,000 (4% to 9%) fail is some way. The most common failures are permanent stiffness; lack of full extension and range of motion; instability and a pain and/or grinding. The reasons for failure include going back to sports too soon; not completing proper post-operative care with a brace or cast; and several possible surgical errors. The graft may have been misplaced, non-anatomically correct, too vertical or too tight. The rehabilitation program may have been poorly designed or the patient had lack of motivation to succeed. Whatever the reason, the condition is called “arthrofibrosis” and this failure will lead to post-traumatic arthritis.
Some patients had successful surgeries and rehabilitations, but end up reinjuring the knee either playing the same sport that caused the original injury or from other activities involving twisting motions of the knee. Whether through carelessness or by accident, the resulting knee injuries will be more complicated, less stable, and require even longer rehabilitation. Most professional athletes are forced to retire after reoccurring knee injuries.