Rehabilitation

ACL Rehabilitation Goals

Preoperative

  • Reduce swelling
  • Regain full extension unless restricted by bucket handle meniscal tear
  • Increase flexion to maximum that is comfortable
  • Regain adequate Quadriceps Hamstring strength by closed chain exercises
  • No pivoting sport

Postoperative

  • Discharge- Same day in the vast majority of patients
  • Pain control is achieved by using infiltration of local anaesthetic in to the joint and wound plus use of a nerve block
  • Discharge from Hospital goals
    • Mobilising safely with crutches including doing stairs
    • Passive full extension and reasonable flexion (60-90 degrees)
    • Outpatient physiotherapy appointment organised

Goals for 0-2 weeks

  • Mobilise with the aid of crutches including indoors
  • Reduce bandage after 24-48 hours
  • Pain relief
  • Reduce swelling- Icing 4-6 times daily 15 minutes each time
  • Regain extension- heel raise and extension stretch, quadriceps bracing exercise
  • Regain flexion beyond 90 degrees
  • Mobilise patella (Patella tendon graft) and no active hamstring curls (Hamstring graft)

Goals for 2-6 weeks

  • Note: The graft does not heal in the tunnels for at least 6-8 weeks
  • Wean off crutches
  • Regain symmetrical hyper extension- heel raise, prone hangs (compare heel height)
  • Regain full flexion by heel slide using a towel (compare heel-buttock distance)
  • Mini squats. Bridging exercises
  • Proprioceptive exercises and improve joint position sense
  • Closed chain exercises- Exercise bike
  • No driving for 2-3 weeks for left knee and 4-6 weeks for right knee

6 weeks to 3 months

  • Closed chain exercises and straight line activities only
  • Gait training, core strength and balance training
  • Improve quadriceps and hamstring strength- exercise bike, cross trainer, Lunges, single leg dips
  • Low resistance and low weights but more repetition
  • Brisk walking, Swimming

3- 6 months

  • More intensive strength training
  • Open chain exercises allowed
  • Start running on a treadmill
  • Regain atleast 80% quadriceps and hamstring strength compared to opposite leg Progress to shuttle runs, side stepping, diagonal lunges, figure of eight and zig-zag runs

After 6 months

  • Sports specific training
  • Plyometric exercises
  • Technique training, plyometric exercises, core strength and balance training prevent further ACL injuries
  • Return to sport at approximately 8 months