Return To Play - ACL | UPMC Sports Medicine

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– An ACL injury can be a game-changer. These types of injuries often require surgery to get back to a high level of play. The ACL program at UPMC Sports Medicine pairs evidence-based methods with clinical expertise to provide individualized care for athletes of all ages, at all levels of competition. It’s never a one-size-fits-all approach. Hi, I’m Charlie Batch. Yes, that Charlie Batch, if the name is familiar to you. I am here today with Volker Musahl, medical director at UPMC Rooney Sports Complex and an orthopaedic surgeon specializing in anatomical ACL reconstruction. Dr. Musahl, thank you for joining me today.

– Charlie, thank you so much for having me. It’s great to be with you.

– So, let’s start off talking about ACLs. What is an ACL?

– So, the ACL is a ligament that’s in the center of your knee. It’s called the anterior cruciate ligament. It is the most important ligament that gives you the ability to cut, and twist, and pivot. Without it, you can’t do that.

– Now, how does an athlete actually injure an ACL?

– So, injuring the ACL is almost like a perfect storm. Certain movements all come together, usually without contact of another player. The knee rotates and twists in a certain way, and then, pop. A sudden pop denotes that injury.

– Is there a surefire way that one tears their ACL?

– Yes. So, if you tear your ACL, unfortunately, you most likely have immediate swelling in the knee. You won’t be able to walk very well on that knee, and the athletic trainer on the sideline, or any medical professional, they can do a test on your knee that surefire gives you the answer.

– Now, when you say test, is that only performed by you, or can the individual actually perform that test by themselves?

– It has to be a medical professional that knows what they’re doing. You can’t really do it on your own. So, it is a test that requires two hands.

– While ACL injuries require careful diagnosis and treatment, healing is possible with the right care team and plan. So, let me ask you this, doc, when an athlete has pain or swelling in their knee, how do you go about performing treatment? So, first when I see an athlete and I hear the story that the knee had popped, and I see the swelling, and all the signs really point toward the ACL, we usually get an MRI next. That’s a study that shows you the inside of the knee, and it shows us the ligaments, the meniscus, and all the other structures. And then, yes, there are some ACL injuries that are partial, that are just stretched, or that can heal. And so we’re looking for those signs to decide whether we need to go to surgery or whether we could try to just let it heal.

– And I think what ultimately determines whether or not they go to surgery.

– So, if an ACL is completely torn, then, Charlie, almost all the young patients that want to go back to twisting, pivoting, and cutting type of motions, they usually go to surgery to get this fixed because otherwise, you won’t really be able to return to that same level.

– Who is a good candidate for ACL reconstruction?

– So, young athletes, male and female, that play contact, high-risk sports — basketball, football, soccer, all these sports — and that have a complete ACL tear, I would say they are candidates for ACL surgery.

– Now, the whole total reconstruction, is that eligible for treatment?

– Yes. What we do is a complete reconstruction of the ligament. We take one of their own tendons from that patient, make a new ACL from it, and after that, you go on to rehab.

– Doc, after surgery, how important is rehab?

– Charlie, I’m glad you’re asking this question. Rehab is very, very important after surgery. You should really have the rehab done by a professional who is in the same team, if possible, as the surgeon. The rehab will take several months, and there are many phases that we are going through. In the beginning, it’s just working on inflammation and the range of motion; later on, getting the strength back; and at the very end, of course, getting all the mobility, the speed, and all the fine-tuning back so that eventually you have a successful return to play.

– Doc, you mentioned recovery time. What’s the average time that it takes to recover from an ACL injury?

– After surgery, we usually get you through a structured rehabilitation program. And at a minimum, it will take eight to nine months to fully recover. And if you ask athletes that have gone through this process, and I can tell you, most of my athletes will try to beat that number I give them. I can tell you that they may return at an earlier time point, but not at the exact same level. And if you ask them carefully, they will all tell you, “Around one year is when I really returned to play.”

– Treatment plans are not one-size-fit-all for ACL repair and recovery, so returning to play isn’t either. Dr. Musahl, when is the right time to clear an athlete to be ready to play?

– Well, Charlie, at UPMC Sports Medicine, we’ve developed individualized programs for return to play. And so each athlete, no matter what sport they’re doing and how long they’ve been in the rehab program, we put them through what’s called a Return to Sports test. It’s a battery of tests where we do an exact assessment, how far along are they in the process. And so we can determine when the right time is because the No. 1 goal for us is that you don’t reinjure; the safety of our athletes.

– And you know how athletes are: We’re eager, we get back onto the field, but there’s a mental side of it as well. Can athletes just jump right in?

– That’s a great question. The psychological aspects are really not so well understood as many of the other aspects. So we have developed programs for this as well. And really, it’s the athlete themselves. Nobody can tell them, “Hey, you are ready to play.” It is the confidence that you want to get back to play, and you don’t have to worry about your knee every single day anymore.

– Dr. Musahl, so what are some of the tips that you would have for athletes who are recovering from ACL injury and now looking to return to the field?

– No. 1, I think you should choose the right team. That’s very important. Work with a team that you are comfortable with, work with a team that’s within your sports organization, that’s who you should work with. No. 2, trust the process; do not be afraid of taking your time getting through all the different steps of this, and trust that day by day, you’re making progress. Don’t think too much about the big picture of returning. And then, No. 3, take your time. Take your time with the entire process, trust it, and you will get back to play.

– Dr. Musahl, thank you for sharing this important information today. If you’re an athlete and feel discomfort in your knee, don’t wait. Contact the experts at UPMC Sports Medicine today. With decades of experience and individualized ACL treatment and injury prevention, the team will work with you to meet your goals. To learn more about the ACL program at UPMC Sports Medicine, visit

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