ACL Reconstruction & Rehabilitation
The goal of surgery is to restore joint anatomy, provide knee stability, as well as return to work and sport as soon as possible.
Some patients achieve satisfactory stability non-operatively. Long-term ACL deficiency may result in gradual damage to the menisci and articular cartilage.
ACL reconstruction is best performed once the knee has recovered from the initial injury, and full range of motion regained.
The damaged ligament is replaced by a graft; usually from the hamstring tendons (gracilis-semitendinosus) or middle third of patella tendon (bone-patella tendon-bone). The graft is passed through bone tunnels and fastened with screws or similar devices for fixation.
Patients generally spend a night in hospital, followed by a period rehabilitation to restore strength, motion, flexibility and proprioception.
The following is a guide to the stages of rehabilitation. They are designed to hopefully reach the best compromise between biological healing and accelerated recovery. If at any stage, recovery is complicated by swelling or pain, then rehabilitation should be slowed to aid resolution.
The actual rehabilitation process will vary slightly from person to person, and also depend on any additional surgery performed.
Please do not shave your legs
Skin problems around the knee may cause a delay in surgery
Advise us of any known allergies
Bring any regular medications and all imaging performed to hospital
Day 1 & 2
The knee is braced initially in extension to allow healing around the graft at the bone tunnels
Regular ice to control swelling
Maintain extension; pillow under heel NOT knee
Protected weight bearing (25-50%) for first 7-10 days
Static quadriceps contractions in extension; No active extension from 40 to 0 degrees allowed for 3 months
Patella mobilisation with quadriceps relaxed; glides and tilts
Opposite Leg Active Assist Leg Extension (OLAALE) for 6-12 weeks
Day 3 to 14
Proprioception; single leg stance 2 times a day for a few minutes, using hands for balance
Continued work on extension
(Prone knee hangs and knee flexion)
(Flexion exercises; prone / seated)
Week 2 to 6
Achieve full range of movement
Full weight bearing
Proprioception; balance without hands / eyes shut / leaning side to side
Closed kinetic chain exercises
(Flexion exercises; prone / seated)
Resisted hamstring exercises; low weight after 3-4 weeks
Swimming; straight kick only
Stationary bicycle riding; no resistance
Co-contractions; lunges, 2 leg quarter squats
Patients should probably wait 6 weeks before driving if their “braking” leg has undergone surgery
Week 6 to 12
Step lunges and half squats
Proprioception; lateral stepping, wobble board
Increase gym work resistance; leg press
Swimming (no breaststroke)
Progress to normal bicycle
Jogging on flat
Month 3 to 6
Proprioception; hopping, jumping, lateral movements
Open chain quadriceps can commence
Sport specific exercises
Strength work; leg curls, half squats, wall squats, rowing machine
Agility work; eg sideways running, skipping rope
Return to training; non-contact drills
Isokinetic testing; aim for quads to be 70% normal
Month 6 to 9
Increase intensity of training, strengthening
Isokinetic testing; aim for quads to be 90% normal between 6-9 months
Aim for return to competitive sport, based on strength, proprioception and symptoms.
These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances. Please contact Mr Chris Kondogiannis’s rooms on (03) 9415 9272, Mr Hayden Morris’s rooms on (03) 9417 7299, Mr Nathan White’s rooms on (03) 9417 7299 if you require further information.