Anterior Cruciate Ligament (ACL) Rehabilitation: Difference between revisions
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=== Before surgery === | |||
RICE and electrotherapy can be applied during several weeks ahead of the surgery in order to reduce swelling and pain, to attempt full range of motion and to decrease joint effusion. This will help the patient to regain better motion and strentgh after the surgery.<ref name="Vijf">I Eitzen, H Moksnes, L Snyder-Mackler, MA Risberg. Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. Journal of Orthopaedic and Sports Physical Therapy 2010;40(11):705-722</ref> | |||
Therapy pre-ops can encourage strengthening of the quadriceps and hamstrings. Range of motion exercises should be included if there is no pain involved.<ref name="Negen">S. van Grinsven, R. E. H. van Cingel, C. J. M. Holla, C. J. M. van Loon. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:1128–1144</ref><ref name="Elf">Savio L-Y. Woo, Richard E. Debski, PhD, John D. Withrow, Marsie A. Janaushek. Biomechanics of Knee Ligaments. The American Journal of Sports medicine 1999;27:533</ref> | |||
[[Neuromuscular Electrical Stimulation|NMES]] combined with exercise is more effective in improving quadriceps strength than exercise alone<ref name="Kyung-Min">Kyung-Min KiM, Ted Croy, Jay HerTel, SuSan Saliba. Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes: A Systematic Review. J Orthop Sports Phys Ther 2010;40(7):383-391.</ref>. | |||
=== After surgery === | === After surgery === | ||
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==== Adjuncts ==== | ==== Adjuncts ==== | ||
NMES - Neurotech's Kneehab XP Quadriceps Therapy System has been shown to significantly improve rehab following ACL reconstruction<ref name="Kneehab">Sven Feil, John Newell, Conor Minogue and Hans H. Paessler. [http://ajs.sagepub.com/content/early/2011/02/20/0363546510396180.full.pdf+html?ijkey=28W1kfCXExivc&amp;keytype=ref&amp;siteid=amjsports The Effectiveness of Supplementing a Standard Rehabilitation Program With Superimposed Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Single-Blind Study]. Am J Sports Med February 22, 2011</ref>. | NMES - Neurotech's Kneehab XP Quadriceps Therapy System has been shown to significantly improve rehab following ACL reconstruction<ref name="Kneehab">Sven Feil, John Newell, Conor Minogue and Hans H. Paessler. [http://ajs.sagepub.com/content/early/2011/02/20/0363546510396180.full.pdf+html?ijkey=28W1kfCXExivc&amp;amp;keytype=ref&amp;amp;siteid=amjsports The Effectiveness of Supplementing a Standard Rehabilitation Program With Superimposed Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Single-Blind Study]. Am J Sports Med February 22, 2011</ref>. | ||
Revision as of 17:54, 25 January 2012
Before surgery[edit | edit source]
RICE and electrotherapy can be applied during several weeks ahead of the surgery in order to reduce swelling and pain, to attempt full range of motion and to decrease joint effusion. This will help the patient to regain better motion and strentgh after the surgery.[1]
Therapy pre-ops can encourage strengthening of the quadriceps and hamstrings. Range of motion exercises should be included if there is no pain involved.[2][3]
NMES combined with exercise is more effective in improving quadriceps strength than exercise alone[4].
After surgery[edit | edit source]
- Week 1
Regular icing and elevation are used to reduce swelling. The goal is full extension and 70 degrees of flexion by the end of the first week. The use of a knee brace and crutches are imperative.
Multidirectional mobilizations of the patella should be included for at least 8 weeks. Other mobilization exercises in the first 4 weeks are passive extension of the knee (no hyperextension) and passive and active mobilization towards flexion. Strenthening exercises for the calf muscle, hamstring and quadriceps (vastus medialis) can be performed.
- Week 3-4
The patient must trie to genuinely increase the stance phase in an attempt to walk with one crutch. With good hamstring/quadriceps control, the use of crutches can be reduced earlier.
- Week 5
The use of the knee brace is progessively reduced.[1][2] Passive mobilizations should normalize motility but flexion should not yet be thorough. 9 Tonification of hamstrings and quadriceps (vastus medialis) can start in close chain exercises. The exercises should be started on light intensity (50% of maximum force) and progressively increased to 60-70%. The closed chain exercises should be built from less responsible positions (bike, leg presses, step) to more congested starting positions (ex.squad). The progress of the exercise depends on pain, swelling and quadriceps control. Proprioception and coordination exercises can start if the general strength is good. This includes balance exercises on boards and toll.
- Week 10
Forward, backward and lateral dynamic movements can be included as well as isokinetic exercises.[2]
- Month 3
After 3 months, patient can move on to functional exercises as running and jumping. As proprioceptive and coordination exercises become heavier, quicker changes in direction are possible. To stimulate coordination and control through afferent and efferent information processing, exercises should be enhanced by variation in visible input, surface stability (trampoline), speed of exercise performance, complexity of the task, resistance, one or two-legged performance, etc.[2]
- Month 4-5
Final goal is to maximize endurance and strength of the knee stabilizers, optimize neuromuscular control with plyometric exercises and to add the sport-specific exercises. Acceleration and deceleration, variations in running and turning and cutting manoeuvers improve arthrokinetic reflexes to prevent new trauma during competition.[3]
- Return to sport
When Should an Athlete Return to Sport After an ACL Surgery?
Adjuncts[edit | edit source]
NMES - Neurotech's Kneehab XP Quadriceps Therapy System has been shown to significantly improve rehab following ACL reconstruction[5].
- ↑ 1.0 1.1 I Eitzen, H Moksnes, L Snyder-Mackler, MA Risberg. Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. Journal of Orthopaedic and Sports Physical Therapy 2010;40(11):705-722
- ↑ 2.0 2.1 2.2 2.3 S. van Grinsven, R. E. H. van Cingel, C. J. M. Holla, C. J. M. van Loon. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:1128–1144
- ↑ 3.0 3.1 Savio L-Y. Woo, Richard E. Debski, PhD, John D. Withrow, Marsie A. Janaushek. Biomechanics of Knee Ligaments. The American Journal of Sports medicine 1999;27:533 Cite error: Invalid
<ref>tag; name "Elf" defined multiple times with different content - ↑ Kyung-Min KiM, Ted Croy, Jay HerTel, SuSan Saliba. Effects of Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction on Quadriceps Strength, Function, and Patient-Oriented Outcomes: A Systematic Review. J Orthop Sports Phys Ther 2010;40(7):383-391.
- ↑ Sven Feil, John Newell, Conor Minogue and Hans H. Paessler. The Effectiveness of Supplementing a Standard Rehabilitation Program With Superimposed Neuromuscular Electrical Stimulation After Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Single-Blind Study. Am J Sports Med February 22, 2011
