Hyperbole maybe. Let’s be honest; millions of people, professional athletes included, have had this procedure, had excellent physical therapy and returned to nearly, if not completely, 100%. However, Robert Griffin III holds a special place in the hearts and minds of everyone in the Metro DC area and for many in and around professional football.
I was recently asked to contribute to a piece on Robert Griffin III regarding his ACL reconstruction, his expected course of rehabilitation and the likely prognosis for a full recovery. I was happy to help a dear friend of mine and a friend of SPARK Physiotherapy, Fairfax Hackley with his weekly segment on WTOP (103.5FM).
Here is a link to the piece that was aired on Monday, 1/14/13 at 2:20PM on ‘Hack’s Best Body Report’: RGIII ACL recovery from WTOP with Fairfax Hackley
The main question asked was ‘what’s in store for RGIII with regard to the specifics of the surgery and his recovery’. One of the most important details here is the type of graft being used to repair his knee. For this surgery, they chose to use a patellar tendon-bone graft (PTB) which has some advantages over other grafts.
RGIII did, in fact, undergo two separate procedures for this reconstruction. A PTB graft can be taken from a cadaver or from the patients own knee when it’s appropriate. The PTB graft was harvested from RGIII’s left knee and arthroscopically implanted into his R knee. If the right knee didn’t previously have a PTB graft removed in 2009 when he first tore that ACL this surgery would only have been slightly less complicated.
Below is a great video that shows what this surgery looks like.
NOTE: the video depicts most of this without the skin and muscle in the way, but in fact, most of either procedures are done with minimal incisions and the entire ACL implantation is done through very small portals (.5-1.0 cm incisions) and small video cameras.
Immediately after surgery, the main goal of the medical and physical therapy teams is to decrease any chance for infection and blood clots. No matter how young or in shape the patient, we are all susceptible to these problems if precautions are not taken. For the first week or two, blood clots are managed by gentle movement of the joint by RGIII and his physical therapist(s). He will use crutches to get around for the first week to 10 days and he’ll wear an immobilizer brace that protects the surgery while he’s moving around.
Once the initial phase of recovery is complete, at around the 2 week mark, the main focus of the rehab is to maximize the protection of the newly implanted graft. All movement will be highly controlled placing very little to no stress on the ACL. During this time the PT team will work with RGIII on exercises that will prevent weakening of his quadriceps, glutes and further decrease his swelling and inflammation.
The next phase of rehab, typically at 4-weeks post-op, will bring us to a stage where more care can be taken to regain range of motion muscular control over the knee, hip and foot. This is also the stage where RGIII will resume walking on his own even if it is with a slower pace but at least he’ll be without the crutches or brace now. As long as his range of motion has continued to improve and the swelling has continued to decrease, the overall intensity of PT will start it’s climb! Good times!!
As the physical therapy team approaches the 8-week mark, things get fun but they are still keeping a close eye on the intensity of movements that might place the new graft at risk. The bone that is attached to the ends of the PTB graft is fully attached to it’s new place. BUT at roughly the 10-week mark, the actual tissue that the PTB graft is made of is undergoing a transformation that makes it quite a bit weaker even though he will be relatively pain free. Special care will be taken at this point to ensure everyone is on the same page about this!
Once we’re at 12-weeks or so, we’re mostly in the clear and the real fun can begin. PT becomes more about introducing plyometrics (jumping and bouncing exercises), introducing light running and intensifying his “closed-chain” training (movements like squatting, lunging, etc).
All told, recovery from this type of ACL reconstruction should take anywhere from 4-6 months. Everyone responds to surgery and treatment differently. RGIII has the best and brightest working with him every day to ensure he’ll be back to terrorize defensive coordinators in NFC East for many years.
We at SPARK Physiotherapy wish him the best of luck for a full return to play.