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Recovery following a routine Anterior Cruciate Ligament (ACL) reconstruction
takes approximately six to eight months depending on your activity
levels. The exercise stages may vary if other treatments have been
undertaken during the knee surgery e.g. meniscal (cartilage) repair
or reconstruction of other ligaments.
After your Anterior Cruciate Ligament (ACL) operation, the hard work
begins. It requires dedication and patience to work towards a good
outcome. It is very important that you follow the advice you are given
as the exercises are specifically related to the stage of healing.
More importantly, they are designed to reflect the amount of force
that the graft can tolerate.
A balance is needed between stimulating the healing process and loading
the new graft. It is important to remember that even if your knee
feels like you could push it harder; the graft may not be ready for
this phase.
All quadriceps (thigh muscle) exercises are designed to reduce the
load on the new graft for the first six months and are classified
as ‘closed chain’ (or ‘weight-bearing’).
This means that they are all performed with the foot placed on a surface
throughout the exercise. This compresses the whole of the lower limb
and shear forces across the knee are minimised. ‘Open
chain’ quadriceps exercises are avoided for up to six
months and are defined as those done without the foot resting on a
surface e.g. leg extensions. They are avoided because they allow the
thigh muscle to pull the tibia forward on the femur without the ground
forces on the foot. This causes a greater sheer stress across the
knee and the new graft.
- To decrease pain by minimising swelling.
- Regain full range of motion (ROM).
- Maintain and improve muscle tone and strength.
- Progressive exercise prescription allowing return to all usual
daily activities including work and sports.
Anterior Cruciate Ligament (ACL) reconstruction surgery is usually
carried out as a day case or overnight stay. You will usually be allowed
to fully weight bear but will need crutches for the first few days
to help you walk. It is better to walk well with crutches than walk
badly without and your physiotherapist will advise you as to when
you no longer require them.
Following Anterior Cruciate Ligament surgery it is common to experience
pain in the knee which is usually attributed to swelling within the
joint and inflammation around the arthroscopy insertion sites and
graft harvest site. Following ‘hamstring-graft’ surgery
(most patients) it is normal to feel discomfort, and experience bruising,
at the back of the thigh and knee. Swelling causes pressure on the
surrounding structures which can impair muscle function and restrict
ROM. Early mobilisation of the knee helps to activate the muscles
thus helping to increase the circulation to the knee. Exercises performed
with the leg raised will also aid in the reduction of swelling whilst
you begin to move the joint and strengthen the knee muscles.
The exercises below are a small selection and should be used as a
guideline to aid in your recovery remembering there is no recipe for
rehabilitation as every case is different. It is important to follow
the advice of your physiotherapist in this early phase and be guided
by them.
Relative Rest - Keep the knee moving as well as having
periods of rest
Ice - To help with swelling, regularly for at least
20 mins four times a day
Compression - In the early days to minimise swelling
Elevation - Especially when ice is applied, aids
drainage, elevate when sitting
Sit with your legs out in front of you, preferably resting your heels
on a sliding surface. Put a sling (towel, sheet etc.) around your
foot then bend your knee using the sling, as far as it will comfortably
go.
Hold it there for a few seconds before straightening the leg. Repeat
20 times.
Sit with your legs straight out in front of you and pull you toes
upwards. Tense the thigh muscles to try and push the back of your
knee against the underlying surface.
Hold for 10 seconds and repeat 10 times.
If you find this difficult try it first on the other leg as often
a reminder of the feeling prompts a better response when you try it
again on the injured leg.
Sitting with your legs out in front of you place a rolled up towel
under your knee.
Push your knee down onto the towel whilst digging your heel into the
surface below. You should feel the muscles at the front and back of
the thigh working together.
Hold that position for 10 seconds and repeat 10 times.
To progress this, repeat the whole process over two, then three rolls
to increase the degree of bend at the knee.
0-120 degrees flexion
Minimal joint swelling
Full weight bearing and normal gait pattern
Two leg squats, static foot lunge, small knee bends
Open chain hamstring exercises
Stationary bike
Full range of movement should be achieved
Single leg squats, stepping lunges, dips
Proprioceptive (balance) exercises
Leg press and hamstring curl progression
Step ups/downs
Cycling, stepper, rower
Jogging on mini trampoline / mat / straight line jog
Exercises for hip, knee, foot of both legs
Swimming (Straight leg kick only)
Increase to sports-specific training
Increase cardio-vascular fitness including pool (normal kicking +/-
flippers)
Increase agility and speed / change of direction work
Increase weights and progress all gym based exercises
Start open chain quadriceps exercises under supervision
Concentrate on plyometric and sports specific exercises
Return to usual training/ skills
Only return to playing contact or twisting sports once your physiotherapist
and surgeon have mutually agreed that you are ready and fit to do
so.
These
rehabilitation guidelines have been prepared with the help of Gill
Cannon and Rachel Galley (Physio Action Ltd. – at David Lloyd
Centre, Leeds and Cannons Gym, Harrogate)
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