Regaining Stability: How to Overcome Knee Instability After ACL Surgery

Recovering from ACL surgery is a journey that requires an organised rehab program, patience, and dedication. Knee instability post-surgery is a common concern, especially for athletes like basketball and soccer players. The ACL is crucial for stabilising the knee joint, preventing excessive forward movement of the tibia relative to the femur. With the right approach, you can regain knee stability. This blog discusses how to achieve just that.

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Understanding the Need for ACL Reconstruction Surgery

Here are some of the reasons a person may need an ACL reconstruction surgery-

Functional Limitations

When someone suffers from an ACL injury, activities like climbing stairs, standing up for an extended time, long walks, etc may seem problematic and difficult. Here’s why you may need ACL ligament surgery-

Reduced Mobility

Due to pain and inflammation, the range of movement of the knee gets restricted which further reduces the mobility of the ankle. Any movement may also result in pain. 

Muscle Weakness & Imbalance

Since an ACL injury restricts the movement of the ankle, the muscles in the affected area become weak due to inactivity. 

Fear of re-injury

If you do not go through the surgery, there is a high chance that the same condition may develop again.

Combined injuries

After an ACL tear, the chances of developing Osteoarthritis (OA) increase up to 15%- 20%, if the person also suffers from other associated injuries like meniscus, or MCL comorbidities.

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Facts to consider before ACL reconstruction surgery

It is important to note that not all ACL injuries require surgeries, the chances of getting  surgery depend on many factors, some of which are mentioned below- 

Graveness of the injury

There are instances where it was observed that patients who suffer from partial ACL tear, have gotten better with the help of physical therapy and braces. Whereas, when an individual suffers from a complete ACL tear; they will require surgery. 

Level of activity

People who engage in sports or activities that involve pivoting, jumping, or cutting typically need surgery to allow a full return to these activities. For those who’re not that active, or are old are advised to undergo physical therapy and it might be sufficient for them. 

Knee instability

Surgery might be necessary if the knee continues to feel unstable or gives away during routine activities. Especially if an individual is suffering from multiple issues like a Meniscus tear or other ligament injury. 

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Causes of instability post-surgery

It is not certain that a person will recover and gain 100% stability back after their ACL surgery, some factors that affect knee ACL tear recovery are mentioned below- 

1. Poor Rehabilitation- The reconstructed ligament needs adequate time to heal and integrate with the knee structure. Proper rehabilitation is needed after the surgery to support recovery. 
2. Graft Failure- Stiffness and a decrease in the range of motion of the knee joint will be observed when there’s a graft failure. Individuals may face difficulties in fully extending their legs, causing issues in day to day activities. 
3. Muscle Weakness- As the individual progresses with the recovery, due to inactivity muscles may get weaker which leads to instability in the knees. 
4. Scar Tissues- Some individuals may develop scar tissues, and excessive build-up of scar tissues also leads to instability in the knees

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What happens in the ACL surgery?

Nowadays, an ACL reconstruction surgery normally includes replacing the torn ligament with a graft. The graft can come from different sources- tissues taken from another part of the body, normally the hamstring tendon, patellar tendon, or quadriceps tendons are considered for the same. Tissues can also be optioned via donor. The two surgical approaches for ACL tear are mentioned below-  

• Primary ACL repair- Primary repair involves suturing or stitching together the torn ends of the ACL to facilitate natural healing. This approach is generally considered for specific types of ACL tears, particularly those involving the mid substance of the ligament. There are advancements in primary repair which are still not so popular.

• ACL Reconstruction- This approach for ACL surgical management is quite popular and preferable as it provides great outcomes. The aim of an ACL reconstruction is to replace the torn ACL with a graft that reproduces the normal kinetic functions of the ligament.

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Steps to overcome knee instability

Now that we know what happens in the ACL recovery surgery and what causes instability after the surgery let’s take a look at some points about how to overcome the knee instability. The steps are mentioned below-

Commitment to physical therapy

When it comes to recovery after an ACL surgery physical therapy holds significant importance. The therapies are structured to restore function and they can be categorised into different phases-

1. Opening phase (week 0-2)- The goal of this phase is to restore the range of motion, reduce swelling and begin strengthening. Exercises after acl surgery may include straight leg raises, quad sets, heel slides, etc. A person also addresses the pain they’re suffering from. Quadriceps and hamstring activation exercises are also initiated along with patellar mobility exercises. 
2. Intermediate strengthening phase (Week 2-6)- The goal of this phase is to increase strength and begin functional movements. In this phase exercises related to increasing the range of motion are gradually increased along with balance and proprioception exercises to enhance joint awareness. The person will also go through cardiovascular conditioning through low-impact exercises like mild biking or swimming. The focus will be given to achieving a normal walking pattern without crutches.
3. Advanced strengthening phase (Weeks 6-12)- The goal of this phase is to further increase the strength and include more functional movements. In this phase, dynamic stability exercises like perturbation drills and single-leg exercises will be included along with functional movements related to daily activities and specific sports demands. The Individual will have to go through drills to improve coordination and control along with cardiovascular exercises and sports specific training if the individual is a sportsman. 
4. Return to sport specific activities phase (Month 3-6)- The goal of this phase is to return to the normal, build endurance, strength and stability. In this phase, the individual will have to go through sport-specific drills to replicate the demands of the chosen activity or sport. Plyometric exercises and running programs will also be included in this phase. 
5. Return to pre-injury activities phase (Month 6-12) - The goal of this phase is to fully return to the activities before the injury. This face is similar to the phase prior to this and differs only in the sense of intensity. 

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Tips for Success:

Here are some facts that may come in handy in your recovery journey- 

Patience and Persistence

Recovery from an ACL injury is a marathon and not a sprint. It is crucial to stay persistent and patient with your rehabilitation regime. Celebrate small milestones and always remember slow and steady wins the race. 

Listen to your body

Avoid pushing yourself too hard, as overexertion can lead to further setbacks. Paying attention to the signs of discomfort, pain, or swelling is crucial. If any of these symptoms occur; you need to relax and take it easy for some days. 

Stay motivated

Setting small and achievable targets will help you stay motivated. You will see the improvement. These targets will provide a sense of accomplishment and will help you stay focused. 

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Key Takeaway

Overcoming knee instability after ACL surgery is a multifaceted process that demands dedication, the right mindset and a structured approach to rehabilitation. By committing to physical therapy, improving proprioception, and maintaining consistent follow-ups, you can regain stability and return to your normal life. It is important to note that recovery takes time and staying motivated is the key to recovery. Granimals offers an all-inclusive program for ACL rehabilitation. We have catered to 3000+ clients in over 46+ countries. You can join us and become a greater animal yourself. Book your call today!

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FAQs (Frequently Asked Questions)

Q1- Is it normal to have instability after ACL surgery? 

Answer- Yes, it is normal to have instability after ACL surgery, it has been observed that 5%-20% of people face knee instability after the surgery. 

Q2- What are the red flags after ACL surgery? 

Answer- Excessive pain in your knee after the surgery is the biggest red flag there is. You must immediately seek help. 

Q3- What does knee instability feel like? 

Answer- Knee instability is the sensation of your knee moving side to side or getting twisted while doing basic activities. 

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