ACL reconstruction rehabilitation advice

 

ACL Surgery Advice Sheet

 

 

The Anterior Cruciate Ligament (ACL)

 

The ACL is one of a number of ligaments at your knee joint which helps to provide static and dynamic stability. The ACL also provides important sensory information, which affects your joint position sense and muscle reflexes – this is known as Proprioception.

 

 

 

 

 

 

Proprioception is very important for correct joint function in daily and sporting activities. Proprioception is diminished following injury to the ACL, and it is therefore very important that this is regained following reconstructive surgery.

 

After surgery, pain and swelling can inhibit the activity of your muscles. This can quickly result in muscle wasting which ultimately can lead to abnormal joint movement and can therefore create further problems.

 

 

 

 

The exercises and advice from your Physiotherapist are designed to assist you in restoring muscle strength, proprioception and a good range of movement at the knee joint. The exercises are progressive and each stage should be followed accordingly. This will be guided by the ward and outpatient Physiotherapists. The exercises need to be performed regularly for your surgery to be successful. Total rehabilitation time is 6-9 months and your Physiotherapy appointments will become less frequent as time progresses. It is up to YOU to comply with treatment and advice. You will quickly be back on your feet but if you do not continue with specific exercises, you will not get the best results from your surgery.

 

Day of Surgery

 

Most ACL reconstructive surgery is now performed as a day case procedure. You will be admitted on the day of surgery and discharged later in the afternoon or evening.

 

The Physiotherapist will see you prior to your surgery to advise you on your brace, walking aids and exercises. This advice sheet will reinforce the information you have been given and set out the basic format for your rehabilitation.

 

 

 

Knee Flexion

 

Sit with the thigh well supported. Slowly slide the foot (of your operated leg) backwards, bending at the knee. Keep your bottom and thigh still. You should feel a stretch in the thigh and knee. This may be painful but it will not damage your knee. Try to push further each time

 

Repeat 10-15 times, 1-2 hourly

 

 

 

 

Static Quadriceps   

 

 Press the backs of you knees on to the bed as firmly as possible to tense up the thigh muscles. Hold for 3 seconds and relax. Repeat 10 times

 

 

 

 

 

 

 

 

Straight Leg raise (SLR) for function

 

Tense your thigh muscle. Keep your knee as straight as possible, pull your foot towards you and lift your leg 6 inches off the bed. Lower slowly. Repeat 5 times.

 

 

This exercise is important to regain control of your knee. Once you can lift your leg easily, you can discontinue this exercise. If you struggle to lift your leg in the first few days, you may use a strap under the ball of your foot to assist.

 

 

 

 

 

 

 

Hamstring Strengthening Contractions:
Sit in chair, heels on floor. Don't move heels but pull back on the operated side to try and bend your knee. You will feel tension in you hamstrings as you resist the floor with your foot. Hold for count of 10. Relax for count of 3. Do 10 repetitions.

Hamstring Strengthening Curls:
Lie on stomach. Slowly pull the heel on your operated side toward your buttock (i.e. bending your knee). This contracts the hamstrings. Repeat         10 – 15 times.

Self resisted Hamstrings:

Sitting in a chair with your thigh supported, place your foot behind the heel of your operated knee. Slowly bend your operated knee as far as you can, while resisting the movement with your good leg.

This can be held in a static position or you can resist the bend through a range of movement.

 

 

Sitting with you leg out straight and well supported, remove or undo your brace. Feel for the edges of your kneecap and using gentle pressure, slowly push your kneecap from side to side 5-10 times, and also glide it top to bottom 5-10 times.

 

 

 

 

It is important to regain full extension of your knee as well as flexion. Place your heel on a block or rolled up towel so there is no support beneath it, let the knee “hang” for 3-5 mins or as tolerated.

 

Repeat 4-5 times a day or as necessary to get your knee straight

 

 

 

 

 

 

Your rehabilitation plan over the next few weeks to 9 months is set out in the following tables as a guide for you and your physiotherapists.

 

 

 

 

 

 

 

 

 

 

 

 

If you have any queries or concerns, please contact your surgeon or your outpatient Physiotherapist.

 

 

 

 

Goals
  • Reduce pain and swelling
  • Range of movement 0 - 100°
  • Focus on full extension (straightening)
  • Work on quadriceps and hamstring strength
  • Maintain cardiovascular fitness and local muscular strength and endurance of other muscle groups

 

Exercise and Activities

 
  • Static quadriceps
  • Rest
  • Ice
  • Elevation
  • Continue static quadriceps and hamstrings exercises
  • Continue active knee flexion and gradually push to increase range
  • Closed chain exercises i.e. foot in contact with floor or pedal, ¼ wall squats, exercise bike. Ensure good lower limb alignment
  • Resisted hamstrings i.e. theraband, ankle weights, self resisted exercises in sitting
  • Calf raises
  • Exercise bike to increase cardiovascular fitness and ROM
  • Patella mobilisations
  • Proprioceptive exercise – 1 leg standing ( on operated leg)

 

Positioning and Ambulation

Weight bear as able with brace and crutches or non weight near until sensation returned to normal.

Continue with crutches until adequate ROM and good muscular control i.e. no limp or giving way

 

Brace for walking only.

 

Remove brace at night, for showering and for patella mobilisations

Time Frame

Operation Day

Days 1-14

 

 

 

Goals
  • ROM    0 - 115°
  • Increased closed chain and functional activities
  • Increase bike/stepper to 20 mins
  • ROM    0 - 130°

 

  • Improve proprioception

 

  • 3 sets of 15 reps at 70% of 1 maximum repetition

 

Exercise and Activities

 
  • Progress ROM exercises
  • Progress to single leg ¼ squat
  • Progress proprioception e.g. wobble board
  • Step ups, step downs and side step ups. Gradually increase depth of step.
  • Leg press 0-60˚
  • Exercise bike and stepper
  • Straight leg kick swimming if wounds well healed
  • Progress to single leg ¼  squat with toe raise
  • Single leg skipping
  • Single leg wobble board
  • Lunges – work to increase amplitude and different directions
  • Power walking
  • Straight line walk and jog. Increase jogging and decrease walking with time
  • Progress weights
  • Progress exercise bike

 

Positioning and Ambulation

Discontinue with crutches if good muscular control and no limp

 

 

Discontinue with brace

Time Frame

2  weeks

6 weeks

 

 

 

Goals
  • Full ROM
  • 1 leg hop > 70% of unoperated side

 

 

 

 

 

 
  • comfortably and confidently manage sports specific drills
  • 1 leg hop at 80%
  • Return to sport with approval of surgeon and Physiotherapist

 

Exercise and Activities

 
  • progress all exercises and activities
  • Proprioception and strength to include 1 leg hopping, add in plyometrics (hopping up and down from step)
  • ¼ squats on wobble board
  • continuous straight line running
  • running upstairs / walking down
  • interval training on bike (alternate high and low intensity)
  • Proprioception and agility. – include figure 8’s and cutting drills
  • Begin sport specific running drills

 
  • Return to sport if

 

1.      Full ROM

2.      No effusion

3.      1 leg hop > 80%

4.      20-25 mins continuous running

5.      1 rep max = 90%

 

Positioning and Ambulation

 

 

 

 

 

 

Time Frame

3 months

4 – 9 months

9 months