ACL Reconstruction Surgery: Rehabilitation

Highlights:

  • Goals of ACL rehabilitation
  • How your physiotherapist can help

Overview:

In my previous blog, I briefly discussed ACL surgical reconstruction versus conservative treatment. Ultimately the end goals for ACL prehab, ACL post surgery rehab and ACL conservative rehab are similar. The path to those goals can differ though. Having a physio and orthopedic surgeon in your corner will ensure you are guided down the correct path and any variations in your case are treated appropriately whether that is a concurrent meniscus injury, secondary low back pain or a previous rupture. The type of surgical repair performed can vary between autograft and allograft. Autografts are when the patient’s own tissue from another body part is used to reconstruct the ACL. Common grafts used are patellar (quadriceps) and hamstring tendons. Depending on the approach used, early rehab can differ and affect which exercises are selected by your physio. Below are general goals of rehab after ACL surgery that are followed but should be supervised with your physiotherapist!

GOALS OF ACL REHABILITATION

Weeks 0-2: Immediate Post-Operation
Focus – Reduce swelling & improve range of motion

  • Reduce swelling with exercise, cryotherapy, and electotherapy
  • Improve knee flexing (bending) to 100 degrees with exercise and manual therapy
  • Improve knee extension to a straight position with exercise and manual therapy
  • Activate quadriceps muscles followed by hamstrings, glutes, calves and core with exercise and neuromuscular electrical stimulation (NMES or EMS)
  • Regaining full weight bearing on surgical leg with gait retraining exercises

Weeks 2-4: Early Post-Operation
Focus – Improve range of motion and initiate balance exercises

  • Minimal to no swelling
  • Knee bending to 115 degrees by week 3
  • Full hamstring flexibility
  • Continued muscle activation and starting balance exercises
  • Quadriceps strength >50% of other leg
  • Maintain cardiovascular fitness

Weeks 4-12: Intermediate Post-Operation
Focus – Improve strength/endurance gradually, continue with balance

  • Full knee range of motion
  • Quadriceps strength 80% of other leg
  • Full squat, good balance and unrestricted walking
  • Increase cardiovascular fitness towards end of the phase

Month 3-6: Advanced Phase
Focus – Normalizing exercise, preparing for return to sport

  • Full lower leg strength and power
  • Return to running and agility drills
  • Sport specific drills and increase cardiovascular fitness

Month 6-12: Return to Sport/Activity 
Focus – Overall conditioning and remaining deficits before full return

  • High level sport specific exercises
  • Gradual progressive return to sport

Bottom Line:

Whether you have undergone ACL surgery or gone the conservative approach, certain goals should be met in a timely manner. Exercise will be one of the most important pieces of your rehab, and your physio will select the most appropriate ones for you. Your physio can also provide adjunct treatments to facilitate your recovery such as manual therapy, modailites (cryotherapy, electrotherapy) and education. 

References:

Brukner, P. & Khan, K. (2012). Clinical Sports Medicine (4th ed.). Sydney, AU: McGraw-Hill.

Douglas, A., Logerstedt, D., Hunter-Giordano, A., Axe, M., & Synder-Mackler, L. (2012). Current conceps for anterior cruciate ligament reconstruction: A criterion-based rehabilitation progression. Journal of Orthopedic & Sports Physical Therapy, 42(7):601-12.

Physiotherapy following ACL reconstruction protocol. (2015) Retrieved from http://www.fowlerkennedy.com

Image credits:
1. https://www.emoryhealthcare.org

2. https://pro2medical.com/products/game-ready-accelerated-recovery-system

3. https://www.e-s-c.fr/echauffement.php

 

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