The anterior cruciate ligament (ACL) is one of the four ligaments in the knee joint that joins your thigh bone to the shin bone. A ligament is a connective tissue. A partial or total tear of the ACL in the knee is a common injury among athletes or people who put pressure in their knee joint. The blog below provides an overview of the best time for ACL surgery after an injury.
When you move your knee or twist it beyond a certain limit this injury occurs. Weightlifting, sports injuries, car accidents, and falling from a height are the main reasons for this condition. Pain, cracking sound, and swelling around the knee joint are the prominent symptoms of this injury. Your doctor is the right person to suggest the best time for the ACL treatment to heal the knee condition.
Why is Time Crucial for this Surgery?
The ACL surgery timing plays a critical role in the restoration or recovery. A delay in the medical surgery can lead to complications such as: Increased risk of meniscal tears and cartilage damage.
On the contrary, the medical procedure, if carried out soon, may result in stiffness and prolonged rehabilitation. As a result, the appropriate time frame for surgery is essential to achieve the best possible outcome.
The variables that are pivotal and decide when the ACL reconstruction should be carried out include:
- The patient’s psychological readiness.
- Getting the injured knee ready for surgery.
Key Factors for the Best ACL Surgery Timing
ACL procedure depends on several factors, which include:
- Severity of the injury
- Patient’s activity level
- Presence of additional knee damage
Generally, ACL reconstruction is recommended soon post injury as it curtails complications. It is on account of the fact that stiffness is already prevalent on the knee. Here is a comparison of early vs delayed vs late ACL reconstruction surgery:
Early Surgery (Within 3 to 6 Weeks)
Most of the surgeons are belive that this is the best time for ACL surgery after an injury. If carried out in the early stages, i.e., within three weeks of the injury, the outcome is a positive result. A report was conducted and it was discovered that individuals who had surgery during this time period recovered faster. And their knee stability was much better than those who delayed treatment.
Keeping in mind, early surgery may not suit all patients. More predominantly if inflammation or swelling persists on the injury.
Delayed Surgery (More than 3 Months)
Delaying surgery for six weeks to three months is allowed in certain patients. It allows a decrease in pain and swelling, thereby leading to healthy tissue development during reconstruction. Patients can strengthen the muscles around their knees.
In this case it can aid in post-surgical rehabilitation. Nonetheless, delaying surgery beyond this window may increase the risk of additional knee damage.
Late Surgery (Beyond 6 Months)
Going for surgery beyond six months is generally not recommended. It is due to the elevated risk of meniscal tears and cartilage damage. Studies have demonstrated that delays beyond six months significantly increase the likelihood of developing these complications. Therefore, timely intervention is crucial to preserve knee health and function.
Diagnosis & Tests
Accurate diagnosis is the initial step to determine the need for surgery. A thorough physical examination can assess knee stability that includes tests like the Lachman test and pivot shift test.
Imaging studies, like magnetic resonance imaging (MRI), provide detailed pictures of the ACL and associated structures. It is to confirm the extent of the injury. Besides, additional tests may be required to evaluate the condition of the meniscus and cartilage.
Treatment Options: Conservative Management vs Surgical Reconstruction
Treatment for ACL injuries vary. And are based on the severity of the tear, the patient’s activity involvement, and all-embracing health.
Conservative Management:
For partial ACL tears or if the condition is a minor one, the above treatment may be appropriate. Physical therapists strengthen the muscles around the knee and use braces to provide a stable knee. Activity is limited to avoid movements that stress the knee. While this can be effective for some, it may not be suitable for athletes or those engaged in high-impact activities.
Surgical Reconstruction:
Surgical reconstruction involves replacing the torn ACL with a graft.
- Autograft Surgery: A surgeon uses a tissue graft from the patient’s own body to repair a torn ACL in the knee.
- Allograft Surgery: It generally requires a tendon from a donor.A doctor inserts it into the patient’s knee for the treatment of damaged or torn ligaments.
The choice of graft depends on various factors, that include:
- Patient’s age, activity level, and surgeon’s recommendation.
A surgeon performs the surgery arthroscopically, allowing for smaller incisions and faster recovery times.
Procedure for ACL Reconstruction Surgery
Choosing the best time for ACL surgery after an injury is crucial for a patient. ACL reconstruction is a surgery to replace a torn anterior cruciate ligament. Usually, it is done with a graft from your own body (autograft) or a donor tendon (allograft). The steps involved during the medical procedure are as follows:
- A patient wears a hospital gown and will be given general or spinal anesthetic.
- An intravenous injection will be given to the arm to provide pain or sedative medication.
- A surgeon chooses which graft tissue to take from the body.
- A thin tube containing a camera, known as an arthroscope, is introduced using small cuts.
- Doctor uses small instruments to remove the torn ACL and install a new graft using screws or other devices.
- A surgeon closes the incision with surgical staples and bandages after inserting the transplant.
Recovery Timeline & Rehab Milestones
Recovery is very essential as compared to surgery. Because if your surgery part does not recover properly, then there is a risk of re-surgery. Here is the ACL reconstruction recovery timeline:
Week 0 – 2: Calm & Protect:
- Elevation, compression, and ice to limit swelling.
- Locked brace in extension; heel-slides and quad sets begin day 1.
Weeks 3 – 6: Restore Motion:
- 0-120° flexion; full extension: goal.
- Closed-chain mini-squats, stationary bike, and straight-leg raises in every plane.
- Get rid of crutches as soon as an untroubled gait is achieved.
Between 2 – 4 Months: Strength & Neuromuscular Control:
- Advance to leg-press ≤ 1.5× body-weight and single-leg Romanian deadlifts.
- Initiate low-impact cardio (elliptical, pool running).
- Add proprioception drills: Bosu balance, lateral hops.
Months 5 – 6: Plyometrics & Agility:
- Box jumps, shuttle runs, figure-8 cuts at 70-80 % game speed.
- Achieve a hop-test symmetry index ≥ 90 % prior to progression.
Between 7 – 9 Months: Return to Sport Testing:
- Isokinetic quad/hamstring strength ≥ 90 % of uninvolved leg.
- Y-balance and landing–error scores at normative level.
- Surgeon + physio give you full practice clearance, followed by competition.
Note: If you are a sports player, you have to choose the best knee brace for sports after ACL surgery.
Follow the Preventive Tips After ACL Surgery
An ACL injury can be avoided by strengthening the muscles around the knee that will increase balance and coordination, and use optimal technique.
The below tips can be followed that include:
- ACL strengthening exercises should be performed on a regular basis, as well as suitable warm-up and cool-down regimens.
- You can balance by standing on one leg for lengthy periods, and by trying to bend the knee while standing on one leg.
- Prior to exercising or sports, a warm up prepares the muscles and improves flexibility.
- Do not overexert or push yourself too hard, especially if you are tired.
Conclusion
Choosing the best time for ACL surgery after an injury plays a central role in the recovery process. Although an initial intervention can lead to a quick recovery and a result-oriented outcome, considering individual circumstances, consulting with a healthcare professional is crucial. It will determine the most appropriate timing for surgery.
