As each patient’s condition is different, specific rehabilitation exercises should be performed in a timely and repeated manner with the surgeon to develop a suitable and individualized rehabilitation program.
After ACL reconstruction, a brace should be worn for 4-6 weeks, and active activities of other joints can be started as early as possible, except for knee rehabilitation.
There will be unavoidable pain during rehabilitation exercises. If the pain diminishes or disappears within half an hour of exercise cessation, there is no tissue damage and the rehabilitation can be continued; if it does not resolve, contact the surgeon promptly.
Muscle strength exercises should be used throughout the rehabilitation program.
The swelling of the knee joint will accompany the entire exercise process until the knee flexion and extension angles of motion and muscle strength basically return to normal, then the knee swelling will gradually subside. If there is a sudden increase in knee swelling, the exercises should be adjusted and the amount of activity should be reduced, and the patient should return to the hospital for review if necessary.
Immediately after functional exercise, apply ice for 15-20 minutes. If you usually feel swelling, pain and heat in the joint, you can continue to apply ice packs 3-4 times a day.
Phase I: 1-7 days after surgery (postoperative edema period)
Brace requirement: Knee brace locked in 0 degree extension position. You can walk on the ground with the help of double crutches, without weight-bearing on the affected limb.
Functional exercise.
Active ankle flexion and extension exercise (ankle pump): forceful, slow, full range of plantar flexion and dorsiflexion activities of the ankle joint, once every 2 hours daily, 1-2 sets of 20 each.
Isometric training: isometric contraction of the quadriceps
Straight leg raise training: after extending the knee, keep the knee joint straight and raise it until the heel leaves the bed surface at 10-15 cm, hold it for 20-30 seconds/time.
Exercise 6 sets of 20-30 reps each day.
Knee mobility exercise: The affected knee is required to be able to passively straighten to 0 degrees and flex the knee at an angle of less than 90 degrees.
Supine closed-chain knee flexion exercise: requires the heel not to leave the bed during knee flexion and to move on the bed surface, called “closed-chain”.
Exercise 4 times a day for about 1 hour each time.
Phase 2: 2-3 weeks after surgery (maximum protection period)
Progress to stage 2 standard: The strength of the quadriceps is freely controlled, and straight leg raise can be achieved with relative ease
Able to fully passively straighten the knee joint
Passive flexion and extension of the knee to 0-90 degrees
Good patellofemoral motion
Reduced swelling of the knee joint
Phase 2 exercise program: Continue the above exercises
Add prone knee flexion exercises
CAM training
Terminal knee extension muscle strength exercises: knee extension strength exercises in the range of near extension (0-20 degrees), 1-2 sets of 20 sets 4 times a day, with 2 minutes rest between sets.
Resistance ankle plantarflexion training: against external resistance, toes are stepped down with force .
Knee mobility exercises: passive knee flexion 0-100 degrees, active knee flexion 0-80 degrees
Standing position: straight leg raise training, hook leg training
Phase 3: Controlled walking phase (4-6 weeks post-op)
Criteria for progression to stage 3: Active knee flexion and extension mobility 0-90 degrees
Further reduction in knee swelling
Exercise protocol at postoperative week 4: Patellar luxation
Passive knee flexion and extension mobility: 0-105 degrees, active mobility: 0-90 degrees.
Prone knee flexion and standing knee flexion exercises can be performed
Plyometric exercises.
Straight leg raise: resistance can be resisted, with resistance gradually increasing from 0.5 pounds (or 250 grams) to 5 pounds (2.5 kg)
Hip inversion, abduction, and posterior extension resistance training: resistance gradually increases from 0.5 lb (250 g) to 5 lb (2.5 kg)
Squat training (0-30 degrees), each lasting 30 seconds, 20 repetitions per set, 3 sets per day
Exercise program 5-6 weeks after surgery: Knee mobility training: Passive knee mobility: 0-125 degrees, active mobility: 0-105 degrees
Resistance training of the N cord muscle: resistance flexion of the knee joint
Phase 4 exercise program: At this stage the patient was able to walk completely off crutches
Warm-up: power bike 15 min
Patellar luxation
Knee flexion-extension mobility: 0-140 degrees passive knee flexion-extension mobility, 0-120 degrees active knee flexion-extension mobility
Strength training
Single leg heel lifts: 20/set
Power bike resistance training: 15 minutes
Squat training: 20 sets per group, 3 sets per day
Balance training: Single-leg stance training on hard ground, or using a balance board
Step-up and step-down training
Hip trainer resistance training: forward flexion, back extension, abduction, adduction