Normally, ACL does not heal after tear or completely tear. In some cases require surgery for replacement of ACL by using patellar tendon or hamstring tendon. If ACL tear does not heal, it can result in an unstable knee. In this blog will guide shortly about ACL rehab after surgery.
Phase 1: week 1-2
Goal
- Control pain and swelling
- Good thigh muscle contraction
- Full knee extension (knee straight)
- Protect knee graft
Management
- RICE: elevate the leg and should apply ice around 20 mins 3 times per day + using bandages around the operated knee
- Weight bearing as tolerated by using crutches
- Wearing a knee brace for 1-2 weeks (remove the knee braces when exercise and sleep)
- Should not bend the operated knee more than 30 degrees for the first 2 weeks
- Not letting the operated knee dangle without support
Exercise
Week 1
- Knee extension
- Heel slide (not do if using hamstring tendon as a graft, should wait until week 4-6)
- Static quads
- Straight leg raise (SLR)
Week 2 (Add these exercises)
- Partial squats (not more than 30 degree)
- Toe raises (both leg)
- Prone knee hangs
- Hamstring curl (not do if using hamstring tendon as a graft, should wait until week 4-6)
Phase 2: week 3-6
Goal
- Control pain and swelling
- Knee bend 100-120 degrees
- Strengthening knee muscle
- Good muscle control
Management
- Using ice around 20 mins 2-3 times per day for controlling pain and swelling
- No open chain exercise like kicking leg straight against resistance
- Focus more on close chain exercise such as squats and lunges
- Swimming (pool walking but no kicking in the water)
Exercise
- Continue previous exercise but increase degrees and times
- Stationary bike (avoid bending knee too much and resistance)
- Lunges (the operated knee is in front)
- Leg press
- Step ups (step on a small box leading with operated knee)
- Hip strengthening such as hip abduction and bridging
- Balance exercise such as tandem stance, single leg stance and toe taps
Phase 3: week 7-12
Goal
- No swelling
- Full knee movement
- Balance on the affected leg
- Continued strengthening muscle
Management
- Swimming (front crawl-straight leg kick), But no breast stroke until 4 months
- Walking on treadmill (flat only, no slope surface or area)
- Cycling (have more resistance on a static bike)
- May start with open chain exercise like kicking leg straight against resistance after 8 weeks (depend on your conditions, your therapist will plan for you)
Exercise
- Single leg squat (look to your leg alignment, need someone or use mirror as a feedback)
- Balance exercise (continue and add more unstable balance such as bosu ball or dura disc)
- Single leg balance with resistance (stand with operated leg and slightly squat then using elastic band around the opposite ankle, and move your leg with resistance in multiple directions)
- Side step ups
- Side crab walk with elastic band around the knee
- Quadriceps stretch
- Continued leg press exercise with more resistance
- Stationary bike
Phase 4: 3-6 months
Goal
- Full squat without pain
- Return to run
- High level of balance
- Good stability
- Full motion and no swelling
Management
- progression of strengthening and balance
- Continued swimming
- Create running programs (start running in a straight line at 40% pace)
- Plyometric exercise (focus on control and good alignment)
- May start some sport specific tasks
Exercise
- continued previous exercise but may increase resistance and time
- Nordic eccentric hamstring exercise
- Jumping (need to focus more in your hips, knees and ankles, to make sure you are in a good alignment) and add more such as side jump and box jumps
Phase 5: 6-9 months return to sport
Goal
- Feel comfortable and confident to return to play sport
- A successful return to sport and normal activity levels
- Single leg hop and single leg squat can do 95-100% of the unaffected leg
Management
- return to play sport with specific training
Reference
Chavisa Wasinchutchwal (PT)
