Few achieve their goals after ACL surgery
A year after anterior cruciate ligament (ACL) reconstruction, most patients still experience knee problems. After two years, only one in four successfully achieved their goals with surgery and subsequent rehabilitation, according to a study from the University of Gothenburg.
Surgery for a torn ACL is often seen as the path back to a normal, active life. In clinical practice, the focus is usually on restoring knee stability and strength, but a large proportion of patients find that recovery takes longer than they expected. The results, published in the Journal of Experimental Orthopaedics, reinforce earlier findings showing that the road back after an ACL injury is often long.
Among the 907 patients followed after surgery, only one in ten (13 percent reported being fully recovered after one year. After two years, the proportion had increased to one in four (28 percent). Those who achieved their goals reported less pain, better knee function, and greater knee-related self-efficacy. They also had lower set rehabilitation goals, but despite this, remained active at a higher activity level than those who did not achieve their rehabilitation goals.
The research team used data from Project ACL, which follows patients over several years with tests and questionnaires on function and well-being.
Belief in the knee
Johan Högberg, licensed physiotherapist and doctoral student at the Sahlgrenska Academy, University of Gothenburg, is the study’s lead author:
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“We saw that many patients continue to struggle with symptoms and uncertainty related to the knee long after surgery. This affected their ability to achieve their goals, often defined as returning to their pre-injury activity. We interpret this as meaning that strength in the quadriceps and hamstrings is not enough. The mental aspect and confidence in the knee are equally important,” he says.
According to the researchers, clear and realistic goals as well as better support during rehabilitation could make a difference in the proportions of patients that feel fully recovered.
“Many dream of returning quickly to their sport, but for most people, success is more about being able to trust their knee and be physical active on their own terms,” says Johan Högberg.
If these findings are confirmed in future research, they could lead to changes in how rehabilitation is planned – moving from standardized timelines toward more individualized and holistic recovery.
Article title:
Only 1 in 10 patients achieve their rehabilitation goals at 1 year and 1 in 4 at 2 years following ACL reconstruction: an analysis of 907 patients
DOI: https://doi.org/10.1002/jeo2.70507
A large proportion of individuals who sustain an ACL injury are young adults. The injury is often sustained during pivoting movements and landings after a jump in pivoting sports such as soccer, handball, or skiing. It is estimated that roughly 4,500 ACL reconstructions are performed annually in Sweden. The reconstruction is done arthroscopically, using a small camera and instruments, and a tendon from the thigh is used to replace the torn ligament.
