"If you have good surgery with good physio, you should get a good result.
"If you have poor surgery with good physio, you can still get a good result.
"If you have good surgery with poor physio, you'll get a poor result."
So I'm told by a surgeon I trust.
And it's fair to say my experience of physiotherapists has been mixed, to say the least, since I started this ACL journey.
Firstly there was the NHS physio that diagnosed my torn ACL in seconds and sent me back to the GP in 2010. She was great.
Then there was the private physio who oversaw my rehab first time around. While the procedure may ultimately have failed, I don't think (subjectively) it was down to the physio as it actually felt really strong by the time I was discharged and until it began to fail three years later.
Next up was the physio I was sent to when I first started noticing problems with the joint again. I was seen by a physio from a private company that held the NHS contract for the area. She was very young and kept asking me to score the pain on a scale of 1-10 (pain wasn't the issue, instability was) before massaging the area for 20 minutes (ouch) and asking me to score it again. This continued for six weeks before I was discharged, no better off and with no mention of ACL failure.
Totally fed up, and also struggling with a shoulder problem that meant there was virtually nothing left I could do at the gym, I went to see a private physio I trusted who had sorted a different problem for me quickly. He took one look, expressed concern that the first surgery had failed, and referred me on to my consultant (and sorted out my shoulder for me in the meantime so at least there was something I could do at the gym!)
The story from there should be a positive one. I should have had the revision ACL reconstruction and gone back to start my rehab with that same physio. Instead, after surgery I was referred straight on to the hospital's own physio team and, not wanting to rock the boat and assuming they'd be working closely with the consultant, I went along with that.
The warning bells should have rung at my first appointment when my allocated physio told me how sorry they were I was in a brace for the first six weeks and how they didn't agree with my consultant's rehab protocol. Everyone's entitled to their own opinion, of course, but it wasn't particularly professional.
Without going into too much detail, the first three and a half months of physio were very poor. I tried to give it time, to be fair to the physio who repeatedly told me their dissertation was in ACL rehab and this really was their area. But after several sessions, any concerns I raised being ignored and an almost complete lack of direction (including being told to come back in three months time after one session - and that I could do anything except contact sports during that time - when I wasn't even able to quarter squat), I decided enough was enough and went back to the physio who'd referred me in the first place.
And thank goodness I did. I didn't have full extension, so it's no surprise I couldn't squat; the muscles were so weak I couldn't do straight leg raises (these hadn't even been covered by the first physio) and we started again. From square one.
Perhaps more worryingly, I've since found out that the hospital physio I initially saw has now been promoted to head of department. The mind boggles...
Anyway, one month after I kick-started things again, I developed a new problem in the 'good knee' and had to undergo surgery for that, which delayed things even further. And now I find myself back to square one following the fall on ice.
Looking back, I'm fairly convinced the poor initial physio I had following the revision surgery has played a part in where I'm at now. It seems logical that the graft was still vulnerable 10 months post surgery as the muscles and proper movement pathways have never been re-established sufficiently to give the joint the protection it needs.
It seems the surgeon's advice holds true.
So, what advice would I offer others going through ACL surgery to improve their chances of a successful outcome? It's quite straightforward: Get yourself a good physio from the start. Make sure they see you regularly, give you clear instructions on what to do between sessions and take any concerns you have seriously. Make sure they're treating you and not a protocol. If you're not happy, find a new physio quickly. And if you do find a good one? Hang on to them, do what they tell you and and tell everyone else about them too. You'll be doing us all a real favour!