Rehabilitation following anterior cruciate ligament reconstruction, or ACLR, will always follow a plan based on phases of healing as outlined in Dr. Robert Manske's text, "Postsurgical Orthopedic Sports Rehabilitation: Knee and Shoulder." These phases may vary in timeline depending upon factors such as the type of graft used, the side of the body from which the graft was taken, and the condition of the patient prior to surgery.
Surgery
One of the most widely used accelerated rehabilitation protocols for ACLR was designed by Dr. Donald Shelbourne. Shelbourne recommends taking the graft from the patellar tendon, which runs over the knee cap and inserts into the tibia or shin bone, on the opposite leg from where the ACLR will occur. According to Shelbourne's Knee Center website: "After years of experience we have found that taking the graft from the opposite knee allows for a faster, more predictable recovery. We choose the patellar tendon over other grafts because it is the strongest tendon in the body and offers the shortest rehabilitation time."
Early Phase Rehabilitation
Dr. Manske's text says the first two weeks of Shelbourne's rehabilitation plan is standard across any postsurgical program. Therapy will focus primarily on wound healing and range of motion to ensure that you can fully straighten and bend your knee to 90 degrees. You will learn how to gain good control of the thigh muscle, and how to minimizing swelling by using ice and elevation. You will be allowed to bear weight, as tolerated, using crutches, but will keep your time up on your feet to a minimum.
Intermediate Phase Rehabilitation
According to Shelbourne's plan, the next two weeks after surgery will push you into gaining full knee mobility and normalizing your walking pattern. This phase will also consist of self-massage on the graft site on the opposite leg to ensure proper healing of the tissue. Specific activities during this phase may include exercises that encourage your leg to fully extend, or straighten. If you do not fully regain this movement during this phase, walking without crutches will be difficult. Gentle strengthening will also continue in this phase.
Final Phases
Phase 3 of Shelbourne's program is termed the "Advanced Strengthening Phase." Here, you are striving to regain symmetrical strength within each leg. Rehabilitation will focus on conditioning activities, such as an elliptical trainer, and strengthening the leg muscles with your foot planted, such as a lunge or squat. Finally, you may return to competition in the fourth phase if you can tolerate conditioning activities without increased swelling and pain or reduced mobility and strength. If you are an athlete, your therapist will take you through functional training specific to your particular sport, taking all of the above factors into consideration.
References
- Shelbourne Knee Center: ACL Reconstruction
- "Postsurgical Orthopedic Sports Rehabilitation: Knee and Shoulder"; Robert C. Manske, DPT; 2006
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