What problems result from heavy lifting after Anterior Cruciate Ligament (ACL) reconstruction?

From the Guidelines

Heavy lifting after anterior cruciate ligament (ACL) reconstruction can lead to several serious complications, including graft rupture, hardware failure, and delayed healing, and patients should avoid heavy lifting for at least 3-6 months following ACL reconstruction surgery to prevent potential problems. The main risks include disruption of the graft, which can cause the knee to become unstable, and excessive strain on the knee joint, leading to pain, swelling, and limited range of motion. According to the most recent and highest quality study 1, exercise interventions should be considered the foundation of ACL reconstruction rehabilitation, and physical therapy modalities can be beneficial as an adjunct in the early phase of rehabilitation. However, the evidence for some modalities is conflicting, and the adverse effects, as well as the cost and time required, probably outweigh any benefits.

Some of the potential problems that can result from heavy lifting after ACL reconstruction include:

• Graft rupture: Heavy lifting can put excessive stress on the graft, leading to rupture and requiring revision surgery 1
• Hardware failure: Heavy lifting can cause the hardware used in the reconstruction, such as screws or plates, to become loose or break 1
• Delayed healing: Heavy lifting can delay the healing process by putting excessive stress on the knee joint and surrounding tissues 1
• Increased pain and swelling: Heavy lifting can cause increased pain and swelling in the knee joint, which can be debilitating and affect quality of life 1

During recovery, patients should limit lifting to objects weighing less than 10-15 pounds and gradually increase activity only as directed by their surgeon, typically following a structured physical therapy program that begins 2-4 weeks post-surgery. The rehabilitation protocol should be based on progression criteria, with time since surgery considered necessary but not sufficient for progression unless coupled with objective physical and psychological criteria 1. Psychological factors, particularly fear of reinjury, are the most significant contributors to not returning to sport, and a contributing factor might be that patients are not exposed enough to a sports-specific training programme 1.

From the Research

Problems Resulting from Heavy Lifting after ACD

• Arthrofibrosis, graft failure, and infection are potential complications that can arise after anterior cruciate ligament (ACL) reconstruction 2
• Heavy lifting may exacerbate these complications, particularly arthrofibrosis, which is characterized by stiffness and limited range of motion in the knee joint
• Graft failure can also occur due to excessive stress on the graft, which can be caused by heavy lifting or other high-impact activities
• Infection is another potential complication that can arise after ACL reconstruction, and heavy lifting may increase the risk of infection by introducing bacteria into the wound

Rehabilitation and Return to Activity

• Rehabilitation protocols after ACL reconstruction vary greatly, but most emphasize early weight bearing, open kinetic chain exercises, and other alternative modalities such as neuromuscular electrical stimulation and blood flow restriction 3
• Clinical milestones are used to determine when a patient is ready for the next phase of a "step-up" rehabilitation program
• Return to sport is a critical factor for many ACL reconstruction patients, and recovery has an important psychological component that has only recently been addressed in the literature 3
• Heavy lifting should be avoided during the early stages of rehabilitation, as it can put excessive stress on the graft and delay recovery

Comparison of Conservative and Surgical Treatment

• The choice of management for ACL rupture depends on the severity of the injury, other injuries in associated structures, the level of fitness, and the athletic goals of the patient 4
• Conservative management involves progressive physical therapy, educating the patient on how to prevent instability, and the use of a hinged knee brace
• Surgical management involves reconstruction of the torn ligament using an autograft or an allograft and ACL repair where the torn ligament is affixed back to the tibia or femur
• Studies have shown that surgical management may offer better outcomes in terms of stability and return to sport, but the evidence is not conclusive, and large randomized controlled trials are needed to prove the benefits of surgical treatment over conservative treatment 5, 4