ACL Rehabilitation – Patient Information

ACL Rehabilitation: Post ACL Reconstruction

  • The rehabilitation is milestone based

  • You need to complete the requirements of each phase before moving on to the next

  • Approximate time frames are outlined

  • At each post-operative appointment, your progress will be assessed

  • You will be referred to an appropriate physiotherapist (or osteopath as an alternative) who will guide you through this programme and outline details of specific exercises which you may perform yourself at the gym

  • The physiotherapist will also give your surgeon feedback with regards to your progress

  • Not everyone attends a physiotherapist (such as if you don’t live close enough to any physiotherapists). Please discuss with your surgeon for your at-home ACL rehabilitation plan

DRIVING AFTER ACL RECONSTRUCTION

Patients should wait 6 weeks before driving if their “braking” leg has undergone surgery

Post-Operative Recovery

Theme: Rest. Swelling, bruising control. Pain control

Week 0 – 2 (approximate)

  • The aim of this stage is to recover after ACL reconstruction surgery. You should spend the time at home resting. Stay mainly on the couch. Wear your tubigrip

  • Take pain killers as required. Stay well hydrated

  • Regular ice to control swelling. Apply ice to your knee for 30mins, 5 or 6 times a day

  • Take pain killers as required. Stay well hydrated

  • Use crutches but weight bear as tolerated

  • Try to lock your knee out straight and tighten the quadriceps

  • Pump the calf muscles every chance you get

ACL Rehabilitation Phase 1

Theme: Range of Movement (ROM)

Week 2-6 (approximate)

  • The main aim here is to achieve a good ROM in your knee. Most importantly complete extension (knee out straight equal to the opposite healthy knee).

  • Practice your knee extension locking exercise (most important), knee bending and prone hanging. Ask your physiotherapist or surgeon for details

  • You should attempt to achieve a normal walking style. Full weight bearing

  • You may commence stationary cycling when comfortable

  • Resume normal daily activities

  • Continue icing the knee. Swelling MUST be minimised

  • This phase usually lasts about 6 weeks but may vary between 3 and 12 for example

  • The simple thing is to do your best and don’t worry about your progress or lack of it. Each person has a unique road to recovery after ACL surgery

  • Sometimes you will be told to slow down or speed up

  • You will have regular reviews with your surgeon and your physiotherapist

  • GOALS: A good ROM, complete extension, no swelling

  • If you achieve all the desired goals you may move on to the next phase of rehabilitation

Exercises for Range of MoVEMENT

  • 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

  • Hamstring stretches

  • Swimming; straight kick only

  • Stationary bicycle riding; no resistance

  • Co-contractions; lunges, 2 leg quarter squats

ACL Rehabilitation Phase 2

Theme: Strength & balance

Week 6 – 12 (approximate)

  • This phase usually lasts about 6 weeks, but may vary between 3 and 12 for example

  • You should now be walking normally and performing normal activities of daily living

  • It is now time to commence a gym based programme emphasising strength of all muscle groups including quadriceps, hamstrings, calf, gluteals, core strength. Balance exercises are also important

  • Activities include walking, cycling, swimming (no breaststroke), rowing

  • Don’t over do it. Ice after activity

  • GOALS: Normal gait, swimming, cycling, one leg squat to 90º

  • If you achieve all the desired goals you may move on to the next phase of rehabilitation

Exercises for Strength & Balance

  • Step lunges and half squats

  • Proprioception; lateral stepping, wobble board

  • Increase gym work resistance; leg press

  • Eccentric hamstrings

  • Swimming (no breaststroke)

  • Progress to normal bicycle

  • Jogging on flat

ACL Rehabilitation Phase 3

Theme: Light agilities

Week 12 – 20

  • You may now commence jogging (if given the all clear)

  • Don’t overdo it

  • Ice after activities

Exercises – Light Agilities

  • Proprioception; hopping, jumping, lateral movements

  • Plyometrics begin – hopping, jumping, etc

  • Zig-zag running

  • 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

 ACL Rehabilitation Phase 4

Theme: More aggressive agility exercises

Week 20+

  • Increase intensity of training, strengthening

  • Isokinetic testing; aim for quads to be 90% normal between 6-9 months

  • Endurance. Fitness

  • Sport specific exercises. Refer to your surgeon and your sport physiotherapist

  • Fifa “The 11 ExercisesThe prevention programme “The 11″ was developed by FIFA’s medical research centre (F-MARC) in cooperation with a group of international experts. “The 11″ is a simple, catchy and time-efficient preventive programme that comprises ten evidence-based or best-practice exercises and the promotion of Fair Play

Download FIFA “The 11″ Injury Prevention Programme – Booklet

  • Recommend the PEP programme. Refer to Video below:

Return To Sport Score

Once you have completed Phase 4 you have essentially completed your ACL rehabilitation.

From about month 9 onwards, you can aim for return to competitive sport, based on strength, proprioception and symptoms.

However, we need to know that you have achieved a state of recovery good enough to protect your “new” knee.

We have developed a score that accurately predicts whether or not you have attained a full recovery after your injury and surgery:

If you pass the test, you are ready to start training.

Once having completed full training, you may PLAY!

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.