ACL Surgery – The Surgeons Perspective

I recently attended a seminar held by two local knee surgeons, Dr Bu Balalla and Dr Bijoy Thomas at HSS in Norwest about current trends with ACL and meniscal surgeries.

ACL and meniscal tears are typically common in the ‘weekend warriors’ (over 40’s males playing soccer once a week with little to no fitness on poorly kept grounds) and genetically more prevalent in females.

But who needs surgery? Surgeons and studies are now suggesting that those with overt instability (the knee giving way ALOT with plant and twist movements), kids or those younger then 40 years old and people over 45 who are symptomatic with ACL and/or meniscal tears should have them repaired.

Why should I have surgery? As surgical techniques improve and more time has passed for studies to be conducted, surgeons are now finding that ACL ruptures will have meniscal degeneration as a result when left untreated – so statistically they are saying that untreated ruptures result in 60-100% osteoarthritis.

When should I have surgery? Having a ACL repair is a pretty substantial surgery with a significant recovery time but to get the best results it’s ideal to have the repair done 4 weeks post injury when you’ve had a chance to do some prehab physiotherapy. Both Dr Balalla and Dr Thomas were very supportive of prehab physiotherapy which allows the patient to achieve as close to normal knee bending and straightening as possible and reduce swelling.

What’s the expected rehab time post surgery? Dr Balalla and Dr Thomas are now setting their clients expectations for a 12 month rehab / return to sport post surgery to avoid re-rupture later down the track. Most of the intense rehab is done in the first 6 weeks when the graft is at its strongest – this allows us to regain full knee straightening and as much knee bending as possible as well as start some closed chain exercises. At the 3 month mark you’re looking at more functional training, e.g. running on a treadmill and at the 6 month mark you should functionally be at the 90% mark. However, you often feel the strongest and most capable at the 3-6month mark but this is actually when the graft is the weakest.

Overall, some very sound advice from the professionals who see these injuries day in and day out who are very focused on patient goals as well.

Deborah Chen, Physiotherapist