Young Athletes: TIMING YOUR ACL SURGERY

By Dev K. Mishra, M.D. President, Sideline Sports Doc

Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Young athletes will typically need 9 to 12 months to successfully return to sports. Pick your most important upcoming events and work backwards for at least 9 months. That’s the latest you should have your surgery.
  • The first 2 to 3 weeks after ACL surgery are hard. Try to have surgery during a school break. If you must have surgery when school is in session you’ll probably need to significantly reduce your workload.

I think I really jinxed everyone’s luck last week by writing about ACL tears in skiers because this week I saw a huge number of young skiers with ACL tears, almost all of whom will require ACL surgery. With that in mind I’d like to devote this week’s post to a couple of important issues regarding timing of surgery for the high school athlete, and in next week’s post we’ll discuss issues about returning to your sport. allograft ACL

First of all, you’ll need a really skilled surgeon, and even better than that would be a surgeon who truly understands the needs of the athlete who wishes to return to sports after surgery. If you don’t have a surgeon already, I’d recommend that you check out the physician finder at the American Orthopaedic Society for Sports Medicine.

Key Point #1: It will take at least nine months to successfully return to your sport

This is one of the main sticking points we often have in discussing the timing of surgery with our young patients and their parents. The sports media has gotten us accustomed to professional athletes returning to their sport at six months after surgery and sometimes as early as four months after surgery. We’ll discuss return to sport in more detail next week but for now I’ll give you one very strong statement: in my 20 years of doing ACL surgery I’ve never seen a high school aged athlete successfully come back to a cutting, pivoting, or power based sport in less than 9 months.

The key word there is “successfully”. Sure, some athletes attempt a return to sport at about 6 months, usually against the advice of their physical therapist or surgeon. But invariably something goes wrong. Their sport performance is bad, the knee becomes painful or swollen, or perhaps they have a reinjury to the knee.

The young athlete’s knee requires a minimum of about 9 months after surgery to really be ready to return to sports, and ideally 12 months. Key point #1 then is to look out over your sports horizon, pick the event or season that’s most important for you and go backwards at least 9 months. That is the latest you should have your knee surgery.

Key Point #2: If you have surgery while school is in session you’re going to miss a good amount of school

ACL surgery can be very successful but the first 2 or 3 weeks after surgery are tough. You’ll typically have a cooling unit hooked up to your knee for most of the day, sometimes you’ll also have a machine that moves your knee back and forth called a “CPM”. When you’re attached to these things it’s not particularly easy to haul yourself into your school. Additionally you’ll be on crutches and probably pretty loopy from pain medication.

For most of our high school athletes the ideal thing is to have surgery when you are on a reasonably long break, e.g. winter break, spring break, or summer. If you need to have surgery during school (see Key Point #1 above) then you may want to speak to your teachers and school officials to arrange a reduced schedule for about 3 weeks.

It’s really easy to get into the mode of thinking “I have to have my surgery right now”, but for all high school athletes having ACL surgery I’d strongly encourage you to think about the points above, discuss them carefully with your family, your surgeon, and your school.

SideLineSportsDoc