Is ACL Surgery As Successful As You Think It Is….Nope!

It is estimated that approximately 100,000 ACL reconstruction surgeries are performed annually.  Undoubtedly, you probably know someone who has had this procedure done or even had it done on yourself.

The public perception seems to be that if you undergo ACL reconstruction surgery, it’s a temporary setback and you will be able to return to playing your sport in about 6 months.  The research done on returning to prior level of play after ACL reconstruction tells a much different story though.

To summarize many of the studies out there – 1 out of 3 people will never play at the same level as prior to their ACL surgery

To put it another way – if 3 people on your team have ACL reconstruction surgery, 1 of them is likely not going to play again.  That’s a rather scary thought!

If you don’t believe me, here are some numbers from a few scientific studies.

  • This study found that after ACL surgery 81.2% reported normal or nearly normal knees, but only 62.2% returned to their previous level of sports.  That means 38.8% did not return to their previous level of sports.
  • A different study found that 82% of patients had returned to some level of sports participation and only 63% had returned to their preinjury level of participation.

knee injury

  • High School & College Football Players: 63% of high school and 69% of collegiate players returned to play after ACL surgery.  However, only 43% of the players were able to return to play at the same level as prior to their surgery (based on player perception) and 30% of players said they were unable to return to play at all after ACL reconstruction.
  • NBA Players: 78% returned to play and 22% did not return to NBA competition after ACL surgery.
  • Division I Athletes (at a single college from 2003-2008): athletes who had undergone ACL reconstruction were 19.6 times more likely to sustain a knee injury.

 

caution

Now, let’s say you have ACL reconstructive surgery, put in the consistent hard work and actually make it back to playing your sport…you’re still not out of the woods yet.

Approximately 1 out of 10 people who have ACL surgery will suffer another ACL injury.
And if you actually make it back to your sport/preinjury level, then 3 out of 10 will tear an ACL.

 

Again, if you don’t believe me, here are some more numbers from scientific studies:

  • This study found that repeat ACL injury occurred in 12% of patients – 6% occurred in the ACL graft (surgical knee) and 6% in the other (non-operated) knee.  They also found that the risk of sustaining a rupture of the ACL graft was greatest in the first 12 months after surgery.
  • This study found that 9.6% of patients had suffered a subsequent ACL injury (5.3% to surgical knee and 4.3% to contralateral knee); and the risk of subsequent ACL injury to either knee was 17% for patients who were less than 18 years old, 7% for patients 18-25 years old and 4% for patients over 25 years old.
  • This study was designed really well in that it looked at the athletes who actually made it back to their preinjury level after ACL reconstruction (so it excluded the athletes who never made it back to their sport).  What they found is that the rate of a second ACL injury within 24 months of returning to sport was 29.5% (20.5% sustained an ACL tear on the other knee and 9% suffered a re-tear)

not so fast

You made it back to your prior playing level and didn’t suffer any more knee injuries, now you can finally breathe a sigh of relief…not so fast.

~50% of people who have ACL surgery will develop arthritis (with associated pain and/or limitations) within 20 years after surgery

 

And I won’t bore you with any more numbers from studies…I think you get the point.

 

Returning to prior level of activity is one of the primary reasons for undergoing ACL reconstruction and the research shows that a significant number of patients never achieve this and even for those that do, there is a percentage of patients who suffer another ACL injury. 

The reasons for these issues are still not fully understood and are definitely multi-factorial.  All aspects of the ACL reconstruction process/rehab are being looked at – from the surgical side of things (different surgical techniques, more anatomical placements/grafts, etc.), to the rehabilitation process (are physical therapists not rehabbing patients well enough, are they not addressing the reason for the ACL injury in the first place, are they not assessing patients properly before allowing them to return to play, etc.), to the patient side of things (do they not emphasize PT enough, did their insurance cut them off early, are they non-compliant, psychological factors, etc.).

If you undergo ACL reconstruction surgery or know someone who does, make sure you/they understand the significance of the injury and that it will take the proper team of clinicians (surgeon, physical therapist, etc.) and consistent, hard work for about 9-12 months (and essentially a lifetime of attention) to give you the best chance of success.

If you have some questions or concerns for yourself (or your son/daughter) after reading this article, don’t hesitate to reach out to me

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