The second episode of the ‘Sky Sport Doctor’ segment, broadcast every Saturday on the sports TV channel with our scientific consultancy, maintained its focus on anterior cruciate ligament injuries. This time, the host was Dr. Fabrizio Tencone, Director of the Isokinetic clinic in Turin.”
How should rehabilitation be done after anterior cruciate ligament surgery?
First of all, it is important to know that surgery is not always necessary.
Sometimes it can be avoided, but if the athlete participates in a sport with a high rotational component of the knee, they should know that surgery is likely required.
Undergoing surgery to “probably” be able to return to doing what they did before.
What do you mean by ‘probably’?
Of course, probably, with high probability, but never with absolute certainty. It is not guaranteed that after cruciate ligament surgery, one will return to doing the same activities as before.
We have seen that the recovery rate is only 63% when analyzing all athletes who have undergone cruciate ligament surgery, while it is as high as 90% among footballers playing in the Champions League.
So be careful, amateur athletes risk recovering less well compared to professionals after cruciate ligament surgery, not because they are operated on less effectively, but due to the amount and quality of the rehabilitation process and post-surgery care!
At this point, what is the optimal rehabilitation after cruciate ligament surgery?
Rehabilitation is a long process, made up of rules to follow.
What we have learned in recent years is that we no longer give precise timelines; it is not known exactly how long rehabilitation will take. Generally, it is said or read that “the player will return in 5-6 months,” but this is not usually true.
UEFA’s scientific studies analyzing Champions League players have shown us that the average time is 7 and a half months.
Therefore, if we want to give the correct expectations to our players, we should talk about approximately 7-8 months for a return to the field.
You said that rehabilitation is a process, what do you mean?
Regarding rehabilitation, I mentioned that it’s a long process with rules to follow.
We tried to identify 5 stages, 5 checkpoints, 5 super-rules to follow.
Rules to follow for:
- safely giving up crutches,
- safely starting to run,
- safely beginning initial sports exercises,
- safely starting on-field rehabilitation,
- and finally, getting the green light to rejoin the team.
When can rehabilitation start after the surgery?
Rehabilitation can even be useful in the weeks before surgery to prepare the knee in the best possible condition for the operation.
After the surgery, it can start just a few days later.
Then, progressively over the weeks and months, the goals we discussed are achieved: for example, when to give up crutches, when to start running, and so on.
- The patient arrives still using crutches;
- then gradually, with the help of pool exercises, they start limping less and eventually walk properly again;
- in the gym, joint mobility, knee flexion and extension, and muscle strength improve progressively, and at this point, running on the treadmill can begin;
- at a certain point, around 3-4 months post-surgery, they are ready to undergo specific tests that measure the progress of rehabilitation: the strength test on the isokinetic dynamometer, the test that evaluates physical condition by measuring lactic acid concentrations, and the crucial motion analysis test to study the quality or defects in various sports movements;
- rehabilitation continues, and the exercises become increasingly challenging, but technology aids the patient in ‘regaining awareness’ of their movements. This is achieved by studying movements in the gym, which we call the green room, to correct errors and start moving as before, or even better if possible.
The rehabilitation process ends on the rehabilitation field, measuring exercise intensity with GPS to ensure they are as close as possible to those of the sport the patient will return to!
And at this point, do you get the final approval to return to playing?
The final approval is obtained when everything has been done optimally and measured; relying solely on observation or experience is not enough to give an authorization that carries significant medical responsibility!
To summarize, the final rules to follow for safely returning to sports after cruciate ligament surgery are:
the surgeon’s approval;
the knee is in perfect condition, not swollen and pain-free;
100% strength recovery;
100% recovery of basic physical condition;
having excellent knee control during sports movements;
finishing with the on-field rehabilitation.
Indeed, it is quite a complex rehabilitation!
Yes, very complex, but if the goal is to rightly return to playing sports as before, this is essentially how it should be done.
If you do things properly and give your best effort, you can return to being the athlete you were before the anterior cruciate ligament surgery; sometimes, you can even come back stronger than before!
