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Current rehabilitation programs following ACL reconstructive surgery typically start immediately following surgery. There are variations to the rehabilitation based on concomitant injuries – such as meniscal injuries, other ligament injuries, bone bruises, etc. There are also variations due to the type of surgery performed ie patellar tendon graft vs hamstring tendon graft or autograft (graft from the patient’s own body) vs allograft (graft from a donor).
Early goals:
- Reduce swelling and inflammation
- Regain full passive knee extension (straightening)
- Gradual return of knee flexion (bending)
- Walking, putting weight on operated leg with brace, initially locked in straight position
- Improving motion of the knee cap (patella)
- Regaining control of the quadriceps muscle that is often inhibited after surgery
- Maintaining strength of the hip and ankle muscles
- Early, basic proprioception training – weight shifts
Progression:
- Progress to full range of motion
- Progress to walking without the brace
- Continue strengthening of quadriceps and hip in straight leg raise positions
- Strengthening of quadriceps, hamstrings, hip – in weight bearing positions
- Gait drills are progressed to stepping in different directions and over cones
- Proprioception exercises progress to single leg standing and to unstable surfaces and eventually to perturbation training
Late stage:
- Plyometric training – hopping and jumping, gradually progressing intensity and complexity
- Running, progressing to cutting drills
- Sport specific training – depending on the activities and skills required for the patient’s specific sport
Reference:
Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Recent advances in the rehabilitation of anterior cruciate ligament injuries. J Orthop Sports Phys Ther 2012; 42(3): 153-171.