My discovery of The ACL Athlete – As a sports medicine surgeon, my most commonly performed surgery is ACL reconstruction. I have learned through training and through my own sports medicine practice that these injuries are life-changing, and that achieving the best outcomes requires a comprehensive team approach. The surgery is a crucial part of the process, but only one part. Preoperative rehabilitation, postoperative rehabilitation, functional progression, and return to play regimens all play a role. I think it’s crucial for me to understand all aspects of the process, so it’s not uncommon for me to read stories from patients’ points of view or from healthcare professionals other than sports medicine surgeons.
The ACL Athlete
Recently I was reading about ACL recovery and ACL surgery experience on reddit (I routinely search for phrases like “acl pain reddit,” “reddit acl,” and “acl surgery experience reddit” to better understand the patient’s point of view) when I discovered the ACL Athlete Newsletter and the ACL Athlete Podcast. The ACL Athlete Podcast discusses everything related to ACL injuries, from the injury itself to research and rehabilitation.
Host Dr. Ravi Patel, a performance physical therapist and coach who has had two ACL injuries himself, invites experts and athletes to share their insights, stories, and experiences. The goal is to raise the standard of care for ACL injuries and rehab. Between answering questions like “why do athletes tear their ACL” and episodes on mental skills training, return to play and return to performance, wound healing after ACL, postoperative rehabilitation, and expectations for ACL surgery, Ravi Patel covers it all. Some of my favorite episodes are listed below:
Success after ACL surgery depends on teamwork. The surgeon, the physical therapist, the performance coach, the patient – no one can do it alone. You also need a support system to help you navigate the process after surgery. Patel describes some of the feelings you will experience after ACL surgery, and why building a team early in the process is very important for you to have the best outcome and best recovery possible. The sports medicine team can include your surgeon, your physical therapist, mental performance coach, etc. Others include your performance coach, your agent, families, friends, teammates.
Kelsey, who has her Masters in sport and exercise psychology, joined the team nearly seven years ago. Years after her ACL injury, she now works alongside injury prevention specialists and physicians to support the whole athlete. Kelsey believes that training the mental game is essential in unlocking the athlete’s full potential, both on and off the field.
This episode discusses how to prepare for surgery. What do you need to do the night before? What will the OR day be like? Being equipped with the knowledge before surgery can help to make surgery day and postoperative recovery go more smoothly. Patel does a great job of explaining it from the patient’s perspective. He talks about getting an IV, nerve blocks, what the anesthesia feels like, and what to expect afterward.
In summary, The ACL Athlete Podcast and Newsletter is an excellent resource for patients with ACL injuries. I highly recommend that anyone who has an ACL injury, or someone who is just interested in learning more about ACL injuries and the surgery/rehab process, subscribe to his podcast and newsletter.
Do you come back stronger after ACL surgery?
The answer is “it depends.” If you are talking from a purely scientific standpoint, then no, it is unlikely that your new reconstructed, or repaired, ACL will be stronger than your original ACL. It is also unlikely that the kinematics of your knee will exactly match your pre-injury status, despite how much we try to restore your native kinematics. The differences may be subtle or imperceptible, but it is unlikely we can get it as good as it was originally designed.
However, from a performance standpoint, there are many athletes who came back “stronger” than they were prior to injury. There is something about going through the adversity of ACL injury and recovery that can mold and hone and athlete’s focus and determination.
Can you tear ACL twice?
Yes, you can tear your ACL twice. This can happen by re-tearing the reconstructed ACL or by tearing the opposite knee’s ACL. Depending on which study you read, the re-tear rate can range from 10-25%. In some patient populations, there is a 30% chance of re-tearing the ACL or tearing the contralateral ACL within 2 years of ACL surgery.
What sport has the most ACL tears?
Women’s soccer and women’s basketball have the highest incidence of ACL tear. A high school female athlete playing either soccer or basketball year round has a 4-5% chance of tearing her ACL each year of participation.
Is surgery always necessary after an ACL tear in athletes with torn ACLs?
Surgery isn’t always necessary after an ACL tear. Sometimes a strain, or a partial tear, can heal sufficiently without surgery. Even with a full thickness tear, some patients are able to function at a high level without the ACL. These patients are called “copers” and account for approximately 5-10% of all ACL tear patients.
There are many factors that go into the decision making process for ACL surgery. This can include the patient’s age, the patient’s activity level, and the patient’s native or inherent knee stability. Sometimes the secondary stabilizers in the knee are sufficient to provide rotatory stability without having a functional ACL. In athletes with a torn ACL, there is an established protocol (Delaware-Oslo) that can help direct operative versus nonoperative management.