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    ACL Rehab - Phase I

    0-2 weeks after surgery

    1st POST OP WEEK—YOU WILL BE DISCHARGED WITH KNEE SUPPORTED IN A BRACE

    IT IS EXTREMELY IMPORTANT THAT YOU WORK ON EXTENSION IMMEDIATELY.

    Goals:

    • Control pain and swelling
    • Care for the knee and dressing
    • Early range of motion exercises
    • Achieve and maintain full passive extension
    • Prevent shutdown of the quadriceps muscles
    • Gait training

    Control Pain and Swelling

    1) Control Swelling. Following discharge from the hospital you should go home elevate your leg and keep the knee iced using the Ice packs. You may get up to use the bathroom and eat, but otherwise you should rest with your leg elevated.

    2) Do not sit for long periods of time with your foot in a dependent position (lower than the rest of your body), as this will cause increased swelling in your knee and leg. When sitting for any significant period of time, elevate your leg and foot.

    3) Control Pain. You will be sent home with a prescription medication. You should take this for severe pain, as directed on the prescription.

    4) As your pain and swelling decrease you can start to move around more and spend more time up on your crutches.

    Caring for your knee

    1) The first night and day after the surgery you can expect the bandages to get bloody. This is normal! We want the blood to drain out of the knee on to the dressings rather than build-up in your knee and cause swelling and pain.

    2) We recommend that you limit weight bearing to prevent swelling. Use Crutches till you are able to bear weight on the leg without any discomfort.

    3) You can start using a stationary bike. Cycling is an excellent conditioning and building exercise for the quadriceps. Start with the seat fairly high and use a short diameter pedal if available so that the knee doesn’t bend too much. At this early stage, you should just “spin” without any resistance. Use your good leg to turn the pedal.

    4) You may shower, but you must keep your incisions dry for the first 7-10 days. This can be achieved by placing a waterproof dressing or plastic bag over your leg.

    5) The sutures, if used will be removed between 10-12 days

    IT IS IMPORTANT TO KEEP THE INCISIONS DRY FOR THE FIRST 7-10 DAYS.

    7) You may remove the knee brace while doing exercises or if you are in a safe, protected environment. However, the knee immobilizer should be worn while sleeping for the first 4 weeks, and at all times while you walk for the first 6 weeks.

    Early Range of Motion and Extension

    1) Passive extension of the knee by using a rolled towel. Note the towel must be high enough to raise the calf and thigh off the table.
    This exercise can also be done by sitting in a chair and supporting the heel on the edge of a stool, table or another chair and letting the unsupported knee sag into full extension.
    2) Active-assisted extension is performed by using the opposite leg and your quadriceps muscles to straighten the knee from the 90 degree position to 0 degrees.

    Hyperextension should be avoided during this exercise.

    3) Passive flexion (bending) of the knee to 90 degrees.

    Exercising Quadriceps

    1) You should start quadriceps isometric contractions with the knee in the fully extended position as soon as possible.

    • Do 3 sets of 10 repetitions 3 times a day.
    • Each contraction should be held for a count of 6 sec.
    • This exercise should he performed 4 to 6 times a day for 10 minutes. It is important to achieve at least 90 degrees of passive flexion by 5 - 7 days after surgery.
    This exercise helps to prevent shut down of the quadriceps muscle and decreases swelling by squeezing fluid out of the knee joint.

    2) Begin straight leg raises (SLR) with the knee immobilizer on 8 sets of 10 repetitions 3 times a day. Start by doing these exercises while lying down.

    REMEMBER TO RELAX THE MUSCLES EACH TIME THE LEG TOUCHES DOWN

    This exercise can be performed out of the brace when the leg can be held straight without sagging (quad lag). Once you have gained strength, straight leg exercises can be performed while seated.

    Exercising Hamstrings

    1) For patients who have had ACL reconstruction using the hamstring tendons it is important to avoid excessive stretching of the hamstring muscles during the first 6 weeks after surgery.
    2) The hamstring muscles are exercised by pulling your heel back producing a hamstring contraction.

    Postoperative Days 8 – 14

    Use the guidelines within this section for days 8-14 after your surgery
    Goals: Physical therapy Maintain full extension

    Returning to work

    • Schedule an OPD follow-up.
    • As the steri-strips get wet, they will peel off. Do not pull at them for the first 2 weeks.
    • After 3 weeks, you may apply vitamin E oil or another emollient to the incisions, as this will improve their appearance.

    Physical Therapy and Full Extension

    REMEMBER THAT IT IS EXTREMELY IMPORTANT TO CONTINUE TO REMOVE YOUR LEG FROM THE KNEE IMMOBILIZER 4 TO 6 TIMES A DAY FOR 10 – 15 MINUTES AT A TIME TO MAINTAIN FULL EXTENSION.

    Returning to Work

    ACL Rehab Phase II 3-12 weeks post surgery

    Postoperative Week 3-4

    Use the guidelines in this section AFTER the second week of your surgery

    Goals: * Maintain full extension

    Achieve 100 – 120 degrees of flexion

    Develop enough muscular control to wean off knee

    Immobilizer

    Control swelling in the knee

    MAINTAINING FULL EXTENSION AND DEVELOPING MUSCULAR CONTROL ARE IMPORTANT

    Maintain Full Extension

    Develop Muscular Control

    1) Start Partial Squats.
    2) Start Toe Raises.
    3) Continue to use the knee brace for walking even if you have good muscle control of the leg. This will protect your graft.
    4) Wean from crutches when you can put full weight on the leg and walk with a normal heal-toe gait and no limp.
    5) You can continue using a stationary bike. Cycling is an excellent conditioning and building exercise for the quadriceps.
    THE BIKE IS ONE OF THE SAFEST MACHINES YOU CAN USE TO REHABILITATE YOUR KNEE, AND THERE IS NO LIMITATION ON HOW MUCH YOU USE IT.

    When can you drive a car?

    • First, you must not be taking any prescription pain medications.
    • During driving the knee brace can be unlocked.
    • Patients who have had surgery on the left knee and have standard transmissions, should not drive until they have good muscular control of the leg. This usually takes 4 weeks.
    • Patients who had surgery on the right knee should not drive until they have good muscular control of the leg. This usually takes 4-6 weeks.

    Postoperative Weeks 5-6

    Goals: * Full range of motion

    * Strength through exercise

    1) Expected range of motion is from full extension to 100 – 120 degrees of flexion. Add wall slides (see Figure 3) and hand assisted heel drags to increase your range of motion.
    2) Continue quadriceps isometrics and straight leg raises (see Figure 9).
    3) Continue partial squats and toe raises (see Figure 10 and Figure 11).
    4) If you belong to a health club or gym you may start to work on the following machines:

    Postoperative Weeks 6 – 12

    By week 6, your range of motion should be full extension to at least 135 degrees of flexion.

    Goals: * 135 degree of flexion

    * Continued strength

    * NO Running on treadmill yet!!

    1) Continue quad sets, straight leg raises, partial squats, toe raises, stationary bike, elliptical machine, leg presses, and leg curls.
    2) Hamstring reconstruction patients can start leg curls in a sitting position. If you develop hamstring pain then decrease the amount of weight that you are lifting, otherwise you can increase the weight as tolerated.

    IT IS IMPORTANT TO AVOID USE OF A LEG CURL MACHINE THAT REQUIRES YOU TO LIE ON YOUR STOMACH. THIS MACHINE PUTS TOO MUCH STRAIN ON THE HEALING HAMSTRIN MUSCLES, AND CAN RESULT IN YOU “PULLING” THE HAMSTRING MUSCLE.

    3) Continue tilt board and balance board for balance training.
    4) Continue swimming program.
    5) Start treadmill Walks (flat only).
    6) You may begin outdoor bike riding on flat roads.

    NO MOUNTAIN BIKING OR HILL CLIMBING!

    Postoperative Weeks 12 – 24

    Goals: * Continued strength

    * Introduce jogging – Do not try and sprint

    * Introduce agility drills

    1) Continue all of week 6 -12 strengthening exercises.

    2) Start straight, forward and straight, backward jogging and light running program.

    3) Start functional running program after jogging program is completed.

    4) Optional fitting for ACL functional brace.

    5) Start agility drills, zig-zags and cross over drills.

    24 Weeks Postoperative onwards (6 -8 months)

    This is the earliest you should plan on returning to full sports.

    Goals: * Start Practicing, warm ups and Plan for gradual returning to sports

    To return to sports you should have: