Post Op ACL Rehab
The most commonly injured ligament in the knee is the ACL, or Anterior Cruciate Ligament. Ligaments connect bone to bone and restrict motion in a specific direction across a joint. The main function of the ACL is to restrict anterior or forward movement of the shin bone in relationship to the knee. It is estimated that there are between 100,000 – 200,000 ACL injuries per year. From the early 1990’s to the middle 2000’s, there was a 37% increase in the number of ACL reconstruction surgeries performed with over 130,00 surgeries performed in 2006.
Anyone can injury or rupture their ACL. Certainly, any direct trauma to the knee can cause ligament damage, but most ACL ruptures occur in a non-contact fashion. Athletes or anyone that perform dynamic movements with their legs, i.e. dancers, are prone to ACL injuries. With a non-contact injury, most ACL injuries occur within the first 33 milliseconds after the foot initially touches the ground.
There are several different options to reconstruct the injured ACL. Using a donor ligament from a cadaver is known as an allograft. If tissue is used from the patient themselves, it is known as an autograft. The two preferred autograft procedures are (1) Bone- Patellar Tendon-Bone graft, where the middle 1/3 of the patellar tendon is used, and (2) a Hamstring Autograft. Graft selection is based upon the surgeon’s preference, the age and activity level of the patient, and the patient’s wishes. The post-operative treatment plan, goals of Physical Therapy, and level of outcomes are the same, no matter what type of graft is used to reconstruct the injured ACL.
There are different phases of rehabilitation after ACL reconstruction surgery. An established post-op rehab program along with the clinical decision-making skills of your Physical Therapist, you will be advanced through the different phases in a timely and appropriate manner. Initially after surgery, it is important that post-op pain and swelling is controlled. It is also equally important to achieve full knee extension as soon as possible. Being able to fully straighten the surgically repaired knee not only assists in walking safely, but there are arthritis implications later in life if full knee extension is not achieved after ACL reconstruction surgery. Protecting the surgical graft is also imperative to return to any running, jumping, pivoting, or dynamic activities. It takes between 10 – 12 weeks for the new ACL graft to heal into the femur and tibia bones and up to 7 months before the new ACL is fully tested to ensure complete recovery from surgery. It may take up to a full year before full strength and neuromuscular control returns to the surgically repaired leg.
Working with your PT, you will safely work on regaining full knee range of motion, learn how to safely strengthen the quadriceps, hamstrings, and gluteal muscles, and learn pain and swelling reduction techniques to ensure you have a complete and tolerable recovery. As different clinical markers are achieved, i.e. specific knee range of motion measurements, muscle strength grades, and pain intensity levels, you will begin to work on more dynamic activities. Beginning with double leg weight bearing exercises – squats and lunges, and then progressing to single leg weight bearing exercises. Static and dynamic balance activities will then begin. Jogging usually begins at 12 weeks post-op. Learning how to jump and land appropriately and safely is an integral part of your post-operative therapy. Once it is deemed safe to begin those dynamic activities, you will be trained on how to perform different jumps (double leg) and hops (single leg). Once someone has participated in a complete post-operative ACL reconstruction Physical Therapy program, which usually lasts between 4 – 6 months, their surgically repaired knee in many cases, is more stable and stronger than the non-injured knee.
ACL reconstruction surgery is one of the most common orthopedic surgeries performed. The operation has ~97% success rate with most patient’s returning to the sport or activity they were participating in when they originally injured their ACL.
Anyone can injury or rupture their ACL. Certainly, any direct trauma to the knee can cause ligament damage, but most ACL ruptures occur in a non-contact fashion. Athletes or anyone that perform dynamic movements with their legs, i.e. dancers, are prone to ACL injuries. With a non-contact injury, most ACL injuries occur within the first 33 milliseconds after the foot initially touches the ground.
There are several different options to reconstruct the injured ACL. Using a donor ligament from a cadaver is known as an allograft. If tissue is used from the patient themselves, it is known as an autograft. The two preferred autograft procedures are (1) Bone- Patellar Tendon-Bone graft, where the middle 1/3 of the patellar tendon is used, and (2) a Hamstring Autograft. Graft selection is based upon the surgeon’s preference, the age and activity level of the patient, and the patient’s wishes. The post-operative treatment plan, goals of Physical Therapy, and level of outcomes are the same, no matter what type of graft is used to reconstruct the injured ACL.
There are different phases of rehabilitation after ACL reconstruction surgery. An established post-op rehab program along with the clinical decision-making skills of your Physical Therapist, you will be advanced through the different phases in a timely and appropriate manner. Initially after surgery, it is important that post-op pain and swelling is controlled. It is also equally important to achieve full knee extension as soon as possible. Being able to fully straighten the surgically repaired knee not only assists in walking safely, but there are arthritis implications later in life if full knee extension is not achieved after ACL reconstruction surgery. Protecting the surgical graft is also imperative to return to any running, jumping, pivoting, or dynamic activities. It takes between 10 – 12 weeks for the new ACL graft to heal into the femur and tibia bones and up to 7 months before the new ACL is fully tested to ensure complete recovery from surgery. It may take up to a full year before full strength and neuromuscular control returns to the surgically repaired leg.
Working with your PT, you will safely work on regaining full knee range of motion, learn how to safely strengthen the quadriceps, hamstrings, and gluteal muscles, and learn pain and swelling reduction techniques to ensure you have a complete and tolerable recovery. As different clinical markers are achieved, i.e. specific knee range of motion measurements, muscle strength grades, and pain intensity levels, you will begin to work on more dynamic activities. Beginning with double leg weight bearing exercises – squats and lunges, and then progressing to single leg weight bearing exercises. Static and dynamic balance activities will then begin. Jogging usually begins at 12 weeks post-op. Learning how to jump and land appropriately and safely is an integral part of your post-operative therapy. Once it is deemed safe to begin those dynamic activities, you will be trained on how to perform different jumps (double leg) and hops (single leg). Once someone has participated in a complete post-operative ACL reconstruction Physical Therapy program, which usually lasts between 4 – 6 months, their surgically repaired knee in many cases, is more stable and stronger than the non-injured knee.
ACL reconstruction surgery is one of the most common orthopedic surgeries performed. The operation has ~97% success rate with most patient’s returning to the sport or activity they were participating in when they originally injured their ACL.