RehabilitationFollowing Anterior Cruciate Ligament (ACL) reconstructionRecovery following a routine Anterior Cruciate Ligament (ACL) reconstruction takes approximately six to eight months depending on your activity levels. The exercise stages may vary if other treatments have been undertaken during the knee surgery e.g. meniscal (cartilage) repair or reconstruction of other ligaments. After your Anterior Cruciate Ligament (ACL) operation, the hard work begins. It requires dedication and patience to work towards a good outcome. It is very important that you follow the advice you are given as the exercises are specifically related to the stage of healing. More importantly, they are designed to reflect the amount of force that the graft can tolerate. A balance is needed between stimulating the healing process and loading the new graft. It is important to remember that even if your knee feels like you could push it harder; the graft may not be ready for this phase. All quadriceps (thigh muscle) exercises are designed to reduce the load on the new graft for the first six months and are classified as ‘closed chain’ (or ‘weight-bearing’). This means that they are all performed with the foot placed on a surface throughout the exercise. This compresses the whole of the lower limb and shear forces across the knee are minimised. ‘Open chain’ quadriceps exercises are avoided for up to six months and are defined as those done without the foot resting on a surface e.g. leg extensions. They are avoided because they allow the thigh muscle to pull the tibia forward on the femur without the ground forces on the foot. This causes a greater sheer stress across the knee and the new graft. Aims of physiotherapy
Day 1- 14 Anterior Cruciate Ligament (ACL) reconstruction surgery is usually carried out as a day case or overnight stay. You will usually be allowed to fully weight bear but will need crutches for the first few days to help you walk. It is better to walk well with crutches than walk badly without and your physiotherapist will advise you as to when you no longer require them. Following Anterior Cruciate Ligament surgery it is common to experience pain in the knee which is usually attributed to swelling within the joint and inflammation around the arthroscopy insertion sites and graft harvest site. Following ‘hamstring-graft’ surgery (most patients) it is normal to feel discomfort, and experience bruising, at the back of the thigh and knee. Swelling causes pressure on the surrounding structures which can impair muscle function and restrict ROM. Early mobilisation of the knee helps to activate the muscles thus helping to increase the circulation to the knee. Exercises performed with the leg raised will also aid in the reduction of swelling whilst you begin to move the joint and strengthen the knee muscles. The exercises below are a small selection and should be used as a guideline to aid in your recovery remembering there is no recipe for rehabilitation as every case is different. It is important to follow the advice of your physiotherapist in this early phase and be guided by them. Initial ManagementRelative Rest – Keep the knee moving as well as having periods of rest Ice – To help with swelling, regularly for at least 20 mins four times a day Compression – In the early days to minimise swelling Elevation – Especially when ice is applied, aids drainage, elevate when sitting 1. Knee Flexion using a slingSit with your legs out in front of you, preferably resting your heels on a sliding surface. Put a sling (towel, sheet etc.) around your foot then bend your knee using the sling, as far as it will comfortably go. Hold it there for a few seconds before straightening the leg. Repeat 20 times. 2. Static Quadriceps Contraction (Thigh Squeeze)Sit with your legs straight out in front of you and pull you toes upwards. Tense the thigh muscles to try and push the back of your knee against the underlying surface. Hold for 10 seconds and repeat 10 times. If you find this difficult try it first on the other leg as often a reminder of the feeling prompts a better response when you try it again on the injured leg. 3. Co-contractions of the quadriceps and hamstrings.Sitting with your legs out in front of you place a rolled up towel under your knee. Push your knee down onto the towel whilst digging your heel into the surface below. You should feel the muscles at the front and back of the thigh working together. Hold that position for 10 seconds and repeat 10 times. To progress this, repeat the whole process over two, then three rolls to increase the degree of bend at the knee. Week 2-6
Weeks 6-12
Weeks 12 – 5 months
Month 5 onwards
Only return to playing contact or twisting sports once your physiotherapist and surgeon have mutually agreed that you are ready and fit to do so. These rehabilitation guidelines have been prepared with the help of Gill Cannon and Rachel Galley (Physio Action Ltd. – at David Lloyd Centre, Leeds and Elev8 Wellness Rooms, Harrogate) |
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