Here at the clinic we see a lot of people after orthopedic surgeries, from ACL reconstructions and hip arthroscopy to rotator cuff repairs and joint replacements. We get so many questions from people going into surgery that we started offering a free preoperative session (contact us to schedule one yourself). Although each and every surgery is unique and different, there are some basic concepts regarding the timelines for returning to your favorite activities.
The goal of the recovery after any orthopedic surgery if for the repaired or reconstructed structures to heal together. This is achieved by holding the structures together long enough for them to “take”. During surgery, the tissues are scuffed to get them to bleed and then stuck together with pins, anchors, and sutures. As long as the tissue doesn’t shift (becomes “displaced”), the healing will occur. Achieving this while getting increased range of motion and strength is the ultimate outcome. So how long do you need to protect it?
Bone to bone healing
Bone to bone healing usually refers to fractures but may refer to certain types of grafts as well (such as the patellar tendon graft sometimes used in ACL reconstructions). Bone will heal to bone generally in about 6-8 weeks. This can be verified by taking an inexpensive x-ray. Once healed, the newly formed callous will actually be stronger than the original bone. This does not mean that the injured body part will be back to normal in 8 weeks, it just means that the bone will be healed.
Soft tissue healing
Just about everything else falls under soft tissue healing. This includes ligaments, tendons, and cartilaginous structures like labrums and menisci. Healing of soft tissue occurs generally in 8-12 weeks. Since there is no way to verify that healing has occurred, we usually just play it safe by waiting 12 weeks and then go by symptoms.
Once enough time passes for tissue healing, then what?
Well, this is where the grey area comes into play. During the initial protective healing phase, activities are performed in rehab to maximize strength and mobility while allowing the tissue to heal. If all of the goals are met by the end of that phase (8 weeks for bone and 12 weeks for soft tissue), overall conditioning activities may begin. If everything goes well, it may only take only another 4 weeks to get back to game condition. If the body is having a difficult time adapting to the newly healed tissue, it could take several months longer. This varies from person to person, injury to injury.