Anterior cruciate ligament, or ACL, surgery is a major operation that will require a great deal of rest and active rehabilitation. ACL surgery will immobilize you for a time, requiring crutches to keep weight off your knee joint. Movement is crucial, however, to maintaining mobility in your knee, and certain types of rehabilitation exercises begin immediately after surgery. Each doctor will have his own physical therapy schedule to restore motion and strength to your knee.
Types of Surgery
ACL reconstruction requires a graft -- taking tissue from other areas -- instead of suturing the tendon back together, which can fail over time. Grafts are taken from your patellar, hamstring or quadriceps tendons. You can also choose an allograft from a cadaver to avoid taking your own tissue. Allografts are typically used if you have failed an ACL reconstruction before or if you need more than one knee ligament reconstructed. If the graft is your own, where it originates is important. For instance, if it is a hamstring graft, your hamstring will need to heal; movement for that muscle may be limited for a time. Your doctor will recommend the proper rehabilitation program.
Post-Operation Movement
Physical therapy actually begins as soon as surgery is complete. You are fitted with a continuous passive motion machine, or CPM, as well as crutches and a brace immediately after the operation. The CPM machine will gently move your knee joint through its range-of-motion, preventing stiffness and promoting nutrient movement into the area. Your doctor will give you recommendations for CPM use; it is typically used two to three times per day for a total of four to six hours per day. Every time you use the CPM you should try to increase the flexion by 5 degrees.
Week One
Other types of movements you can perform are called active-assisted exercises. You perform these by using the opposite leg and your quadriceps muscles to straighten your injured knee from the 90-degree position to 0 degrees. Use your uninjured leg to slowly lower your injured leg into a bent position. Performing this movement can begin soon after surgery, as you should achieve 90 degrees of flexion five to seven days after your operation.
Weeks Two to Four
As soon as you can perform them without pain, unassisted exercises are recommended.Quad sets, or tightening your quadriceps while your leg is straight, is an excellent exercise to begin early after your operation. Begin straight leg raises -- while lying down in your brace -- a few times a day to help reduce swelling. First contract your quadriceps to prevent strain on your graft, and raise your leg to between 45 and 60 degrees. Knee extensions and heel slides are also performed during this time to help strengthen your quadriceps muscle.
Weeks Three to Five
Typically during weeks three to five -- when you have normal range of motion -- you can begin using an exercise bike or a stair stepper for cardiovascular fitness. Moderation is recommended, and if your knee is painful or swells significantly after your workout, stop the exercise and talk to your doctor.
Week Six and Beyond
With your doctor's permission, you can begin resistance or weight training. Typically, close-chained exercises are performed. These exercises mean that your foot remains immobile while you perform the exercise. Squats and the leg press are two examples of close-chained exercises. Your doctor may wait three months or more before allowing you to return to agility exercises and regular weight training.
