After surgery
After leaving the operating room, the knee joint is protected by a brace. The knee is cooled with an ice bucket to reduce pain and swelling. This machine should be used continuously until the 3rd – 4th day after surgery and held for approximately 30 – 45 minutes at 1 hour intervals. After this time, the ice can be used by the patient to provide the desired comfort. The post-operative brace helps to maintain extension and is worn continuously during walking and sleeping.
Post-operative rehabilitation exercise program for 1-7 days.
Goal: Pain and swelling control
Care of the knee dressing
Early joint range of motion
Achieve and maintain full passive extension
Prevention of quadriceps atrophy
Gait training
Early flexion and extension exercises
1. Passive exercises to straighten the knee joint.
Raise the calf and thigh by placing a towel on the heel, please note that the towel must be high enough to raise the calf and thigh. Please refer to the preoperative exercise knee extension diagram. While awake, exercise every 2 – 3 hours by removing the brace, placing your heel on a pillow or folded quilt so that the knee is suspended and passively allowing the knee depression to fully extend for 10 – 15 minutes. Relax your muscles and straighten the knee joint by muscle gravity.
2. Active exercise to straighten the knee joint
Using a healthy leg to assist in elevating the affected side, the quadriceps on the affected side actively contract from 90 degrees to 0 degrees to straighten the knee. In this exercise, hyperextension should be avoided.
3. Passive flexion of the knee joint to 90 degrees.
Sit on the edge of a bed or table and allow gravity to gently bend the knee. The other leg is used to support and control the degree of flexion. Performing this exercise should be done 4 to 6 times a day for 10 minutes each time. 5-7 days later to achieve a postoperative knee that can be flexed at least 90 degrees.
Exercising the quadriceps
1. The quadriceps isometric contraction exercise should be started as soon as possible. Three times a day, 60 strokes each time. Each contraction should be held for a count of 6 seconds. This exercise can help prevent quadriceps atrophy and reduce knee swelling by squeezing the fluid in the joint cavity.
2. Start straight leg raising exercises. These exercises need to be done lying down in the early stages. The leg is fully extended and the quadriceps contraction is performed first. The quadriceps contraction “locks” the knee and prevents excessive stress from being applied to the reconstructed ACL. Keeping the leg straight, elevate to about 45-60 degrees and hold for 6 seconds, the leg is then slowly lowered back to the bed, relaxing the muscles. The exercise is performed for 8 sets of 10 reps each, 3 times a day. Once you feel some strength in your thigh muscles, you can take a seated position to perform knee extension and elevation exercises
Exercise N rope muscle
1. For patients who have reconstructed the ACL using the N cord tendon, avoid hyperextending the N cord muscle 6 weeks after surgery.
It takes about 6 weeks for the N cord to heal, and too much stretching of the N cord during this time may result in increased muscle pain when “pulling” the leg.
Usually when trying to reach forward for your socks and shoes on the floor, there can be unintentional pulling of the N cord muscle.
To avoid re-injury to the N cord muscle, during the activity of mildly bending your knee joint, thus relaxing the N cord muscle.
2, Performing heel sliding exercises with the heel towards the hip can cause contracture of the N cord muscle. If a patellar tendon graft is performed to reconstruct the ACL, this exercise should be performed. If reconstructing the ACL from your N cord tendon graft, as mentioned earlier, this exercise should be avoided during the first 4-6 weeks.
Postoperative 8-10 day rehabilitation exercise program.
Goal: Physical Therapy
Maintain full extension
Physical therapy and full extension
1. Physical therapy at the first postoperative follow-up clinic visit.
2. Continue to do quadriceps isometric contraction, straight leg raising exercises, active flexion, and active assisted extension exercises.
Post-operative rehabilitation exercise program for 2-3 weeks.
Goal: Maintain full extension
Achieve 100 – 120 degrees of flexion
Have sufficient muscle strength to remove the brace
Control knee swelling
Maintain full extension
1. Continue full passive extension , gravity assisted and active flexion, quadriceps isometric contraction and straight leg raise.
2. Work on 90-100 degrees of active knee flexion
Develop muscle control
1, Start the deep squat portion.
Stand with your feet shoulder-width apart in a slightly externally rotated position.
Hold the table with both hands to maintain stability and slightly bend the knees to move the hips forward up and back down.
Hold for 6 seconds, then repeat 10 times, 3 sets per day.
2. Tiptoe exercise.
Hold the table with both hands to maintain stability, gently lift your heels and keep your feet balanced.
Hold for 6 seconds, slowly drop back down, and repeat 10 times, 3 sets per day.
3, Continue to walk with knee pads, even if you have good muscle control of the knee joint. This will facilitate the healing of the graft.
4, When off the crutches, you can put your full weight on the surgical side leg, control your normal gait, and do not walk with a limp.
5, You can continue to use a stationary bicycle. Cycling is a great way to condition and strengthen your quadriceps. Maintain good posture throughout the exercise. The goal is to slowly increase the time spent on the bike, starting at 5 minutes and eventually going to 20 minutes.
3-4 week post-operative rehabilitation exercise program.
Objective: Full range of motion
Exercise muscle strength
1. The expected range of motion is from full extension to 100 – 120 degrees of flexion. Wall sliding and hand assisted heel sliding can increase your range of motion.
2, Continue quadriceps isometric contraction with straight leg raise.
3, Continue localized deep squats and tiptoe exercises.
4, If you belong to a health club or gym, you can start exercising on the following machines.
Stationary bike. Seat position slightly higher in height to avoid excessive bending or straightening of the knee. Tolerance to increased resistance. Try to work out for 15-20 minutes at a time. Swimming: walking in the pool, jogging in the water.
Rehabilitation exercise program 4-6 weeks after surgery.
Goal: 125 degrees of flexion
Continue muscle strengthening exercises
1. The desired range of motion to be achieved should be full extension up to 125 degrees of flexion. Begin with
Complete flexion exercise. If flexion mobility cannot be met during the exercise, a sliding wall exercise is required to assist.
2. Continue straight leg raise, partial squat, toe raise, and stationary bike exercise.
3. Vertical board and balance board exercises. This helps build your balance and proprioception
6-12 weeks post-op rehabilitation exercise program.
Goal: 135 degree flexion
Continue muscle strengthening exercises
Introduce treadmill
1. Continue straight leg raises, partial squats, toe raises, and stationary bike exercises.
2.Continue tilt board and balance board balance training.
3.Continue swimming sessions.
4.Start exercising on the treadmill (flat) .
5.You can start cycling on a flat road outdoors.
12-20 weeks post-operative rehabilitation exercise program.
Goal: Continue muscle strengthening exercises
Start jogging
Begin agility drills
Determine if you need a brace
1. Continue all 6 to 12 weeks of strengthening exercises.
2.Start straight line running, jogging forward and backward.
3.After jogging is completed, functional running exercises can be started, agility drills, sawtooth running and straddle drills can be started.
Post-operative rehabilitation exercise program in 6 months.
Goal: return to sports
To return to sports you should have.
1, quadriceps strength of at least 80% of the normal leg
2, N cord muscle strength of at least 80% of the normal leg
3, normal knee mobility
4, No swelling of the knee joint
5.Good knee stability
6, Ability to complete running