There are four major ligaments in the human knee, including the anterior cruciate ligament, commonly referred to as the ACL. Injuries to the ACL are extremely common in athletes. Small ACL injuries such as strains may be able to healed with physical therapy, whereas ACL tears almost always require surgical repair. Post-surgery rehabilitation is necessary with all ACL reconstructions. Although everyone progresses at a different rate, the same general progression is usually followed during rehabilitation.
Preoperative
There is often a period of lag time between ACL injury and the actual repair of the ligament. Although some strength will be lost with surgery and rehabilitation, the goal of the preoperative period is to maintain as much quadricep strength as possible. The stronger the muscles are at the time of surgery, the faster rehabilitation will be postoperatively. Quad sets are an easy way to strengthen the muscles without placing additional pressure on the knee. To perform a quad set, the leg should be extended and relaxed. The quadricep muscle should be contracted as hard as possible and held for ten seconds without lifting the foot. The exercise should be repeated several times with 10 second rest periods between each set.
The First Two Weeks
There are two major goals for the first two weeks after ACL repair: Minimization of swelling and regaining range of motion. Ice and elevation are key components of the treatment regimen to help minimize inflammation. You will be referred to a physical therapist after surgery to help develop and progress your rehabilitation as needed. . Common exercises performed during this period may include knee extensions, quad sets, straight leg raises and heel slides. These exercises should challenge you but not cause significant amounts of pain. Special consideration should be given to performing the exercises gently and gradually to help avoid reinjury. Patients are generally prescribed crutches during this period to avoid placing pressure on the leg while walking.
Three to Five Weeks
At this point, you should be able to ambulate without the assistance of crutches under the guidance of your doctor or physical therapist. The goal of this period is to increase flexion of the knee and regain normal and full range of motion. The same exercises used in previous weeks to increase quadriceps strength are generally continued. Low impact activities that challenge the flexion of the knee may be added if you can participate without causing significant pain and discomfort. Swelling should still be monitored closely, and any exercise that results in dramatic swelling after performance should be lessened or discontinued until it can be well tolerated.
Six Weeks and Beyond
This period of rehabilitation focuses on building strength while allowing the ligament to continue to heal. Many physical therapists employ closed-chain kinetic exercises which do not allow movement of the foot during performance during this time. Weight machines such as the leg press and knee extension/flexion machine may be included in a workout program at this point. Weight should be added conservatively and gradually. Returning to competitive and recreational sports is generally not advised until after three months post-op.
References
- ACLSolutions.com: Phase I: preoperative period
- ACLSolutions.com: Phase II: 0 to 2 weeks after surgery
- ACLSolutions.com: Phase III: 3 to 5 weeks after surgery
- ACLSolutions.com: Phase IV: 6 weeks after surgery
- Chester Knee Clinic and Cartilage Repair Centre; Accelerated ACL Reconstruction Rehabilitation Program; February 11, 2011
- Gundersen Lutheran Sports Medicine: ACL Reconstruction Rehabilitation Program
