Rehab Guidelines For Intra-Articular Reconstruction of the Anterior Cruciate Ligament
Surgical reconstruction of the ACL has become a common procedure in today’s orthopedic clinics. Rehabilitation of the knee is performed in a physical therapy clinic. Research by physicians and physical therapists has led to the development of specific guidelines or protocol for rehabilitation. This protocol, with your compliance, is designed to give you, our patient, maximum benefits from reconstruction.
Goals of Rehabilitation
- Minimize pain and swelling in the knee.
- Rehabilitation within the limitations of the healing process.
- Protection of the joint during rehabilitation.
- Achievement of good patellar (knee cap) mobility.
- Promotion of muscle strength in the leg.
- Independence in home exercise program, incision care, and application and wearing of postoperative brace.
Your doctor is the best source of information on how your rehabilitation should progress and what types of activities are best for your recovery. However, listed below are some general guidelines that may help you gauge your progress.
Prior to your operation, you will be given information that will explain the surgery and recovery process in-depth. You will also be given instructions that will help you prepare for adaptations you will need to make following the surgery.
- You will be instructed on how to use crutches on flat surfaces and stairs
- Your rehabilitation schedule and goals will be discussed
- Emphasize importance of regaining full extension of knee and full range of motion
- Obtain baseline measurements such as Cybex ® testing and passive and active range of motion
- Fitting of the postoperative knee brace
Your doctor will give you instructions as to how much weight you may put on your knee and how to set and wear your knee brace.
- Begin rehabilitation exercises shown on the back of this handout. Your doctor may also suggest additional exercises that would be beneficial
- Perform hip strengthening exercises at the clinic with hip machine and theraband. Instructions will be given so that you can perform these exercises at home
- Begin ankle pump exercises with resistance of theraband
Maximum Protection Period
Weeks 2 – 3
Your doctor will advise you as to how much weight you can bear on your knee, and adjust your brace to allow for increased movement.
- Continue exercises in handout
- Begin riding a stationary bike using the uninvolved leg
Weeks 4 – 5
Your doctor will advise you as to when you are able to walk without crutches, and how to adjust your brace for increased movement.
- Continue exercises in handout
- You will be instructed in and begin performing multi-angle isometric exercises for hamstrings and quadriceps
- In the clinic, begin leg press machine and theraband leg presses at home
- Begin Cybex ® machine and exercises in the clinic at low speed with proximal pad
Weeks 6 – 7
The goal is to control the forces on the knee while walking.
- Continue to perform all exercises previously recommended at home
- Your doctor will tell you when you can stop wearing your brace
- Cybex ® isokinetic extension exercises with anti-shear device at slow speeds
- Initiate swimming if a pool is available
Weeks 10 – 12
- Your doctor will measure and fit you with a functional knee brace
- Your doctor may suggest additional exercises for your rehabilitation, such as mini squats and lateral step up
- In clinic, you will begin two-legged stationary bike riding
- Begin vigorous walking while wearing your brace
At about 4 months
- You can begin using a stair stepper in the clinic
- Continue all exercises, swimming, and leg press
- Begin running in chest deep water if a pool is accessible
Moderate Activity Phase
At about 6 months
- Begin interval running program
- Progress from straight line running to figure eights and then to lateral shuffles
Return to Full Activity
From 9 – 12 months after your surgery
- When Cybex ® testing indicates quadriceps are 80 percent of the uninvolved leg strength and hamstrings are 90 percent, resume participation in athletic activities
- Continue home exercise program
- Wear your brace for all activities which involve cutting motions such as basketball, football, and soccer
- Perform exercises 4 times per day
- Begin with 2 sets of 10 repetitions progressing to 4 sets of 10 repetitions
- Use ice before and after exercise for 15 minutes as needed for pain and swelling
Lie back with the affected leg straight out and the other leg bent at the knee. Tighten the thigh muscles on top of the extended leg by flattening the knee — the kneecap should move slightly upward. Hold for 5 seconds, then relax the muscles.
Three Plane Straight Leg Raises
To the front: Lie on your back lift the affected leg 8 to 12 inches. Hold for 5 seconds, then slowly lower and repeat.
To the back: Lie on your stomach and lift your affected leg straight up behind you. Hold 5 seconds, then slowly lower and repeat.
To the outside: Lie on your side and lift the affected leg 12 to 24 inches. Hold for 5 seconds and then slowly lower and repeat.
Lie down on a firm surface. Bend the affected knee and slowly slide your heel towards your buttocks as far as possible. Hold your knee bent for 5 seconds, then slide heel back down slowly.
Ankle Pumps (ABC’s) with Theraband
At the ankle, rotate your foot, making circles. Each “circle” should be as large as possible. You may use this motion to form letters of the alphabet rather than circles as your range of motion improves.
Seated Hip Flexion
Sit on the edge of a chair or other firm surface with your feet resting on the floor. Lift your knee toward your chest and hold the position for 5 seconds. Relax and return your foot to the floor.
Passive patella mobilization
Sit on a chair or other firm surface with your affected leg extended. Place your thumbs above your kneecap and your fingers at the sides of the knee. Slowly, gently push down your kneecap. Then let the knee cap slide back into place. Work the kneecap in all directions with your thumbs.
For more information about intra-articular reconstruction of the anterior cruciate ligament, please call (918) 494-AOOK (2665).