ACL Reconstruction – Post-Treatments

Thousands of articles have been written on the various means an athlete can take to help prevent the most devastating of knee injuries – the complete tear of the ACL Anterior Cruciate Ligament. Unfortunately fewer articles have been written for the patient on what to do following an ACL reconstruction with less than hoped for results.

The ACL is the most famous of knee ligaments because of the frequency and the professional and sports notoriety of the injury.

The ACL is a strong connective band deep in the knee that helps prevent hyperextension and provides stability. Interestingly, tears of the ACL occur more without physical contact and instead are linked to the twisting of the knee while the foot remains planted. In a healthy ligament this twisting typically requires a great deal of force to cause a tear, especially a complete tear or rupture in such a strong ligament. The problem is many times the ACL is not a strong as we think it is – it does get weak with overuse.

A portrait of the ACL and the tendon replacement
If you look at a picture of the human anatomy, you will see that muscles are big and red. They are red because of the abundant blood supply that runs through them that helps them grow and repair. Ligaments on the other hand are small and white and resemble thick rubber bands. They are small and white because they do not have an abundant blood supply run through them and because of this, usually do not heal well from injury. This can also hamper the recovery from partial ACL tears. Tendons are equally devoid of a natural blood supply, this is important because many people have a hamstring tendon tunneled and screwed in to the bones to replace the completely ruptured ACL.

Intraarticular hyaluronic acid  injection following ACL reconstruction

A March 2022 paper (1) examined the problems of pain, swelling and joint stiffness following arthroscopic ACL reconstruction (ACLR) surgery that according to the paper ” restrict early return to sports and athletic activities. The patients often receive prolonged analgesic (pain relief) medications to control the inflammatory response and resume the pre-injury activities.” The goal of this study was to evaluate the safety and efficacy of intraarticular hyaluronic acid  injection following ACL reconstruction (ACLR).

The researchers examined post published medical research and identified four studies that would best answer their question on the effectiveness of intraarticular hyaluronic acid  injection following ACL reconstruction (ACLR).

  • There were 182 patients in the intraarticular hyaluronic acid injection group and 121 patients in the control group. In comparison analysis the researchers found: “Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of intraarticular hyaluronic acid injection following ACLR surgery.”

Jumping weakness after ACL reconstruction

A May 2022 study (2) suggested that single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. Here is what these researchers wrote: “Vertical jump performance (height) is a more representative metric for knee function than horizontal hop performance (distance) in healthy individuals. It is not known what the biomechanical status of athletes after anterior cruciate ligament (ACL) reconstruction (ACLR) is at the time they are cleared to return to sport or whether vertical performance metrics better evaluate knee function.” Here is what the researchers found: Jump performance, assessed by jump height and Reactive Strength Index, was significantly lower in the involved (ACL reconstructed knee) than the uninvolved limb and controls, with large effect sizes. During vertical jumps, male athletes after ACLR at return to sport still exhibit knee biomechanical deficits, despite symmetry in horizontal functional performance and strength tests. Vertical performance metrics like jump height and Reactive Strength Index can better identify interlimb asymmetries than the more commonly used hop distance and should be included in the testing battery for the return to sport.

1 Tripathy SK, Varghese P, Behera H, Balagod R, Rao PB, Sahoo AK, Panda A. Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review. Journal of Clinical Orthopaedics & Trauma. 2022 May 1;28.
2 Kotsifaki A, Van Rossom S, Whiteley R, Korakakis V, Bahr R, Sideris V, Jonkers I. Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes. British Journal of Sports Medicine. 2022 Feb 7.

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