Anterior Cruciate Ligament (ACL) Rehabilitation
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[4].
- ↑ Cite error: Invalid
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<ref>tag; no text was provided for refs namedNegen - ↑ Arna Risberg, Inger Holm. The Long-term Effect of 2 Postoperative Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction A Randomized Controlled Clinical Trial With 2 Years of Follow-Up. The American Journal of Sports medicine 2009; 37: 1958
- ↑ 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
