San Diego Youth Athletes: How Long Does it Take for ACL Tears to Heal?

This is one of the most common questions we get asked from athletes all over North County, from Del Mar to Poway. Everyone wants to know how long does it take for ACL injuries to heal and how long will it take to get back to their sport after an ACL surgery. The answer to this question may surprise you.

It was a normal weekend watching your daughter and her teammates at the various fields throughout San Diego. The team has been looking great this past month and is really looking forward to the State Cup tournament. Once the first game starts it is apparent that it is much more competitive than the team have recently faced and as the game continues deep into the second half, it is coming down to the wire.

With the game on the line you watch in anticipation as your daughter takes a side step to avoid the defender’s tackle when she drops and immediately grabs her knee in pain. She is unable to finish and the fear is she has torn her ACL. Many of her teammates have experienced this but fingers are crossed that it is not that bad.

Traditionally when an athlete injures their ACL, they consult with an orthopedic surgeon to confirm diagnosis with an MRI (fancy picture of the knee joint that can show the health of the ligament). Upon receiving that gut wrenching confirmation of an ACL tear, a date is set to perform a surgical repair (often using a tendon from the hamstring or patellar tendon).

This news often is accompanied by a slew of emotions and concerns and rightfully so. ACL injuries are dreaded by all athletes and it wasn’t that long ago when it was considered to be career ending. However, that is no longer the case and it is now more possible than ever to come back from ACL injuries. With that being said, the surgery and how the athlete rehabs plays a crucial role in how quickly and more importantly, safely the athlete returns to sport.

Once an athlete is diagnosed and the surgical procedure date has been selected, the next best thing is to immediately start the rehab process. The process can be very overwhelming and concerning but getting straight to work for an athlete is invaluable. A great place to start is by getting a baseline of the strength of the non injured leg before it weakens because of rest. This is something we cover here in the first part of our ACL rehab blog series.

So, how long will it take for an ACL injury to heal? First and foremost, the answer to this question has MANY variables and varies depending on who is asking the question. Young athletes (middle school, high school and college ages) are among the most affected populations by ACL injuries⁽¹⁾, and here in North County San Diego youth sports has such a competitive culture. Because of this, the article will focus on youth athletes.

Injured athletes and parents often have one main concern; when can that athlete get back on the court or field and do so with confidence and as little risk of re-injury as possible. With so many outside pressures like potential scholarships, other kids continuing to play, the next season coming fast, etc the stakes feel higher than ever to get back to playing as fast as humanly possible. But what is the right thing to do? When should an athlete safely come back to play after an ACL tear and ACL surgery?

We feel that the San Diego youth athletes deserve nothing but the best when it comes to rehabbing an injured ACL, preventing re-injuries and/or preventing ACL injuries altogether. This is why it is so important to us to help parents and athletes from Mission Bay to Del Mar to Poway to San Marcos have a clear understanding of the process and what elite physical therapy and rehab looks like for their athletes.

Traditionally, the timeline that is provided to athletes and their parents when consulting with physicians is nine months to a year. When parents and athletes hear this, it is concerning to think about all of the missed tournaments, games and fun with their friends on the field/court. This can be really frustrating to parents and heartbreaking to athletes, especially if there lacks a clear understanding and rationale as to why it does indeed take this long (and for some even longer) to come back and play after an ACL injury.

Without a rationale as to why it takes this long, the number feels arbitrary and very general. So let me explain a little more as to why it takes this long to heal from an ACL injury.

A very popular study has shown that when an athlete is returning prior to 9 months it comes with exponential risks in re-injury. To be more specific, for every month an athlete delayed returning to sport there was a 51% decreased risk for re-injury all the up to 9 months.⁽²⁾ This is an indication that as timelines go, the expectation needs to be set that the process will indeed take at least nine months. However, this is often misunderstood to mean that time alone is the biggest indicator to get back on the field.

Timelines may be a good Northstar when setting expectations on how long it takes to play after an ACL surgery but they do nothing to tell us how ready an athlete is to get back on the field or court from a physical and mental standpoint.

What is helpful for an athlete to stay focused on the rehab process is creating milestones that become goals to hit during the rehab process. This becomes the proof of concept. For example during the early phases, the number one goals are to minimize swelling as much as humanly possible, restore range of motion as much as possible, regain quad contraction and control as well as restore gait.

Each phase of the rehab process should be marked by milestones that an athlete can achieve, like leveling up in a video game. By the end the athlete should be as strong as the non-injured leg, jump as high and as powerfully as the non-injured leg, look athletic when sprinting, cutting and jumping and finally have no doubt in their body’s ability to compete at high levels.

From an athlete’s perspective, having goals to train for gives them a purpose and an achievable plan to keep them engaged with laser focus. Those athletes who are able to achieve a variety of strength and power tasks prior to returning to sport have less risk of reinjury⁽³⁾. This is why we use this as criteria to earn time on the court or field.

Returning to a sport is earned by how ready the athlete is, not by waiting a certain amount of time. Therefore, the rehab process should be meticulously planned to prepare the athlete for the high demands of their sport via strengthening muscles of the entire leg, lifting heavy weights to expose to higher forces, quality movement strategies to avoid compensation, sprint drills/jumping/cutting to expose to fast forces, and continual coaching feedback.

If your athlete is not getting this level of care, we are here for you. Book a phone call to see how we can get your athlete started on a program to rehab like a pro athlete!

Sources

1. Sanders TL, Maradit Kremers H, Bryan AJ, Larson DR, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. Am J Sports Med. 2016 Jun;44(6):1502-7. doi: 10.1177/0363546516629944. Epub 2016 Feb 26. PMID: 26920430.

2. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016 Jul;50(13):804-8. doi: 10.1136/bjsports-2016-096031. Epub 2016 May 9. PMID: 27162233; PMCID: PMC4912389.

3. Toole AR, Ithurburn MP, Rauh MJ, Hewett TE, Paterno MV, Schmitt LC. Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs? J Orthop Sports Phys Ther. 2017 Nov;47(11):825-833. doi: 10.2519/jospt.2017.7227. Epub 2017 Oct 7. PMID: 28990491.