Frequently Asked Questions

Q: What can I do to prevent an ACL injury?

A: The basic principles of prevention include balance, strength, and position. These can be achieved with some simple exercises that you can even do while waiting for the bus or brushing your teeth. Start standing on one leg and hold it for a long as you can. If you are good at it, try with the knee that is in the air in a bent position. Try it with your eyes closed. Do single leg squats while watching TV. Hop around the room on one leg and make sure your hip is bent and that your knees are over your toes. Little kids can learn to jump off small heights and to bend their knees and keep their knees over their toes as they land. These are basic exercises that can develop good balance and good habits in kids at a young age. If kids are taught these habits very early on, these practices could persist into adolescence.


Q: I had my ACL reconstructed. What is my risk of re-tearing it?

A: It depends on your activity level. In general, younger patients are more active in terms of cutting and pivoting sports, so their risk is much higher. The more you play and the harder you play, the more risk. Females are at higher risk than males, so competitive teenage female athletes in sports such as soccer, volleyball, lacrosse, and basketball are at the highest risk of all. If the risk for all comers is generally believed to be five to ten percent, it could be twenty percent or more for the highest risk group, particularly if they are not following a proper prevention program. On the other hand, if you are over forty and don’t participate in any cutting and pivoting sports but instead concentrate on sports like cycling, golf and weight training, your injury risk is probably under five percent, irrespective of graft choice.


Q: My child is growing. Can she have ACL reconstruction?

A: The short answer is yes, and she probably should, pending other circumstances. Kids have a very high rate of meniscal tears and arthritis after untreated ACL tears. Certainly, any children who have recurrent giving way should have the operation. The problem is that kids often won’t disclose their problem for fear of a trip to the operating room, and, if treated non-operatively for any reason, they must be observed closely by their parents for complaints related to the knee and signs of swelling, which can be telltale. Of course, the surgeon you choose to care for your child must be well versed in techniques that are safe for the growth plates, including “physeal sparing” and “trans-physeal” surgeries that put children at the lowest risk possible.


Q: When is the best time to have surgery?

A: Ideally, you should have no swelling, or nearly none, and have a full range of motion. If you have surgery while the knee remains swollen and you lack motion, you risk developing a stiff knee, which can be a difficult problem to solve. This was often the case twenty and thirty years ago, before we realized the importance of restoring motion prior to surgery as well as the necessity of proper rehabilitation. It usually takes four to six weeks after the initial injury for the knee to be ready for surgery, but some patients can be safely operated on prior to that, and others take longer for motion to return. There are other factors which can force the surgeon to operate earlier, such as a displaced meniscal tear that must be repaired.


Q: How long is recovery after surgery?

A: Typically, crutches are required for four weeks, at which point most people can walk normally. Strengthening is then required until the patient is strong enough to run, which is typically at three to five months after surgery. Return to sports is at six to twelve months. There is significant individual variation, and there is a wide range from person to person.