Can I Return to Running Post-ACL Surgery?

Q  Three months ago, I tore my ACL (anterior cruciate ligament) while skiing. I had ACL reconstruction one month ago and am nearly back to full range of motion, but I’m in a high-risk category for developing arthritis. Should I stop running?


A  It is tough to slow down after an ACL tear and reconstruction, but it is important to allow the articular cartilage of the tibia and the tissue used to reconstruct your ACL to heal completely. It is not always easy to judge when those tissues are ready to handle the stress and strain of running. Pain is a good marker, but not always precise for judging tissue readiness. Ligaments like the ACL are dynamic tissues and when stressed to the level of injury will repair and maintain length. When a ligament is not “vital,” a stretch will remain without recovering the original length, so you are stuck with a longer than intended structure and a less stable joint. If you used your own tissue to replace the ACL, you should revitalise faster. How long it takes to be truly functioning ligament tissue, is the question. I would give the tissue a year before stressing it.

Straight ahead running puts very little stress on the ACL so you can likely get back to some running when you are comfortable and your surgeon is satisfied you are healed. It is also important that you strengthen your glutes and butt muscles to help control your leg motion and reduce your risk of damaging the ACL in the future. Your PT should be helping you with that portion of your rehabilitation.

The other issue is the tibial cartilage damage. This is the part of the ACL disruption that accelerates total joint replacement. Quite honestly we do not have a good understanding of who will have cartilage loss or when it will occur. We know from the Scandinavian literature that teens and young adults who have ACL tears, with or without repair, often require total knee replacements 10-20 years earlier than age and sport matched teammates. I was 58 when I tore my ACL – skiing – and had a total knee replacement at age 60. A little accelerated compared to the younger Scandinavians. That said, we do not know for sure if it is the injury or the activity that accelerates the need for knee replacements. My take is I would pursue the activities you enjoy as long as you are pain free. I might not take on a marathon or half-marathon, but the 5-8km 3-5 times a week with other less impact-loading activities sprinkled into the mix seems reasonable to me, especially if you keep your strength up.

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