Knee rehab a long process

The road to recovery from a serious knee injury is an arduous one at best. Those who wish to… The road to recovery from a serious knee injury is an arduous one at best. Those who wish to travel on it cannot rush, nor can they be faint of heart.

For Pitt receiver Derek Kinder and defensive tackle Gus Mustakas, who both suffered anterior cruciate ligament (ACL) tears this year, coming back anytime soon is not going to be easy.

“Personally, I think it takes a really long time to fully heal,” Dr. Freddie Fu, chairman of orthopedic surgery at Pitt’s school of medicine, said. “It takes much longer than the amount of time some people spend because they want to go back and play.”

Coming back early can be disastrous.

“Patients will feel good and painless, but they don’t know that their knee hasn’t healed yet,” Fu said.

There are several steps in the long process of returning to sports that involve cutting, and there are important parts that cannot be overlooked in properly healing and rebuilding the knee.

Starting under the knife

Recovery starts with surgery, which usually takes place once the swelling from the tear subsides. Kinder and Mustakas each had surgery the week following their injuries.

The kind of ACL repair, single or double bundle, could have an impact on how speedy their return is and how effective the players are once they’re back.

Fu repairs ACL tears with his patented double-bundle method. Based in Pittsburgh, Fu is a pioneer of a new way to repair the knee’s most injured ligament.

Fu believes the ACL has two bundles, not one, which control the operation of the ligament. This belief differs from the age-old idea that there is only one bundle controlling the ACL.

“The single-bundle operation has been successful over the years,” Fu said. “I believe we can improve on it, though, and my surgery does that.”

Fu’s double-bundle surgery already shows signs of improvement: It reduces pain, residual stability and the chances of arthritis later in life.

“After double-bundle reconstruction, we have found most patients to have excellent range of motion,” Fu said.

In his patient information handout, Fu noted that the range-of-motion results are “better than the single-bundle ACL reconstruction and can be seen as early as one to three months after the surgery.”

Once the ACL is repaired, the patient starts the challenging rehabilitation process. It is one of the toughest projects an athlete will ever work on, and doing it properly, or improperly, could make or break the athlete’s career.

Rehabbing a rusty wheel

In Fu’s patient information handout, the rehabilitation guidelines are simple.

On the day of surgery, the patient needs crutches. After one month, the crutches are gone. Two weeks later, the brace is gone, too.

Three months after the surgery, the athlete can start jogging and running in line.

“You have re-build the muscle around your knee,” Fu said. “But first, you need to get used to moving around at any kind of speed, and you have to make sure your knee feels right when you run.”

Sport-specific agility training should only come six months after the surgery, and even then, it’s better to err on the side of caution.

“If you go back too early, it doesn’t matter if I do a perfect double-bundle,” Fu said. “The longer you spend flexing your knee, fixing your reflexes and strengthening your leg, the better. You can feel good and feel like you’re ready to go, but you might not be.”

Prognosis: Don’t push it

In Fu’s dream world, athletes wouldn’t return sooner than nine to 12 months after surgery. But Fu understands the competitive drive in athletes and their program’s desire to return its valuable assets to the field.

“These athletes are worth thousands if not millions of dollars to their programs,” Fu said. “They are investments. So while we don’t like them to go back too early, they almost always want to be back in half a year.”

Rushing the return can endanger the athlete’s future, even beyond their playing years.

“In three to five years, your knee could be worn out,” Fu said. “There could also be other injuries not fully healed in your knee that come with tearing your ACL, like a meniscus or cartilage injury.”

To Fu, an athlete’s time is precious, but it’s not worth the risk of re-injuring one’s knee, and probably ending their career.

“After all,” Fu said, “you only have two knees.”