Is ACL Reconstruction Surgery As Successful As We Think It Is?

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.
Let’s take a look at some of the numbers from some research studies (I included links to the abstracts of each article):
  • The authors of this study wanted to determine how many of their patients who had ACL surgery returned to their previous levels of sports.  While 81.2% reported normal or nearly normal knees, only 62.2% returned to their previous level of sports.  That means 38.8% did not return to their previous level of sports.
  • This study did a systematic review of the research out there and found that 82% of patients had returned to some level of sports participation and 63% had returned to their preinjury level of participation
  • Here is some data on football players who had ACL reconstruction:  of 147 patients (high school and collegiate) who identified football as their primary or secondary sport,  63% for high school and 69% for collegiate players returned to play after ACL reconstruction.  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.

  • And some data on NBA players who had ACL reconstruction: over a 10 year period, 78% returned to play and 22% did not return to NBA competition.
  • This study did a review of patients who had a transphyseal ACL reconstruction (a type of ACL reconstruction performed in young patients with open growth plates).  38% had another operation performed, 28% tore the ACL in their other knee, and only 41% returned to and maintained their preinjury level of play.
  • This study looked at division I athletes at a single institution from 2003-2008 and found that athletes who had undergone ACL reconstruction were 19.6 times more likely to sustain a knee injury.
To summarize many of the studies out there and put it into real-life terms, think of it this 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!

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.
  • This study found that repeat ACL injury occurred in 12% of patients – 6% occurred in the ACL graft (surgical knee) and 6% in the contralateral (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 systematic review analyzed 6 high-level research studies and found that the overall rate of subsequent ACL injury was 11.8%.  The rate of ACL graft rupture ranged from 1.8-10.4% and the rate of injuring the ACL in your other knee ranged from 8.2-16%.
Essentially, 1 out of 10 people who have ACL reconstruction surgery will suffer another ACL injury.

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.
  • I won’t bore you with any more numbers from studies, rather I’ll just tell you that the risk of developing osteoarthritis in your knee after ACL reconstruction surgery increases significantly – roughly half of patients have arthritis with associated pain/impairments 20 years after surgery.
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.


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