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Why Wait to Repair an ACL?

Written on November 12, 2008 at 9:48 am, by Eric Cressey

Q: I was just curious: why would surgeons have waited so long to repair Brady’s ACL? It seems that it would be ideal to do the surgery as soon as possible after the injury to give him more time to rehab and come back.

A: It actually has less to do with the anterior cruciate ligament (ACL), and more to do with the associated injuries he (presumably) had. It’s widely speculated that he ruptured both the ACL and medial collateral ligament (MCL).

A MCL will heal on its own, in most cases, so they’ll give it 4-6 weeks to do so before going in to do the ACL reconstruction. Had he experienced a lateral meniscus tear, though (as is common in traumatic ACL injuries), they’d have gone in pretty quickly. ACL injuries that also include the lateral meniscus are typically much more serious and potentially career-threatening.

With all ACL ruptures, they’ll usually have folks wait at least a few days to allow the swelling to go down. In some cases – particularly with really deconditioned individuals, they might opt for a period of physical therapy prior to the surgery to strengthen the surrounding musculature, reduce swelling, and ensure full knee extension ROM to improve post-op outcomes.

If you’re interested in learning more about knee function and injuries, Mike Robertson has actually pulled together some great stuff with his Bulletproof Knees Manual. It’s definitely worth checking out.

All that said, best wishes to Brady for a speedy recovery. Us Pats fans look forward to seeing him back on the field.

3 Responses to “Why Wait to Repair an ACL?”

  1. Mike Reinold Says:

    Good answer Eric, I’ll share the perspective of a physical therapist. It is actually common and preferred to delay surgery after ACL injuries to allow the joint to settle down. The timing is individualized based on the patient and their response to the injury. Generally, if an inflamed, swollen, and tight knee undergoes surgery, it is going to be even more inflamed, swollen, and tight after surgery! As Eric mentioned, this is especially true with a concomitant MCL injury. The MCL is outside of the joint and has a good blood supply that facilitates scarring and healing. You would like for the MCL to begin to lay down scar prior to surgery so that you are not battling loss of motion from both the surgery and the healing MCL.

    Preoperative physical therapy is designed to reduce swelling, improve range of motion, restore active control of the quadriceps muscle (which shuts down after injury), and to normalize their gait. In some patients this takes days and others weeks. Having a successful preoperative rehabilitation program would actually speed recovery in the long run.

    Mike Reinold

  2. Rick Kaselj Says:

    Eric & Mike,

    Great post.

    Thanks for filling in a few blanks for me when it comes to the MCL, LCL and ACL.

    Rick Kaselj

  3. Janine DeFeo Says:

    My daughter had her acl repaired yesterday. Can you tell me how many degrees we should be up to with each session?

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