The rehabilitation procedures after arthroscopic anterior and posterior cruciate ligament reconstruction of the knee cannot be fully standardized yet. The rehabilitation procedures vary depending on the bone tunnel positioning method, graft, fixation method, fixation material, as well as the conditions of the patient and the conditions of the medical institution.
The following is the rehabilitation program we currently use, with a concise protocol for the majority of patients. We believe that overly complex protocols are poorly executable and difficult to adhere to. For patients in the early post-operative period after cruciate ligament reconstruction, the most important thing is actually the flexion angle. Of course, for individual patients, the situation may still vary and the specific protocol is still subject to the surgeon’s orders!
Post-operative rehabilitation of ACL reconstruction
1, crutches and brace use time: postoperative turntable adjustable brace fixed for 2-3 months, after 8 weeks, except when walking, the rest of the time can remove the brace; crutches need 6-8 weeks.
2, weight-bearing requirements: after surgery, the affected limb can be partially weight-bearing, supporting the crutches to the ground, 8 weeks of full weight-bearing. Deep squatting is prohibited within six months.
Ankle pump training: Ankle pump training is valuable to promote venous return and reduce the risk of thrombosis, and should be practiced immediately after waking up from anesthesia, as many times as possible. The specific method is: active flexion and extension of the ankle joint, the maximum angle of hooking the toe (hook the foot upward, so that the toe is facing towards oneself) and then step downward (so that the toe is downward), maintaining about 3 seconds on the maximum angle, and around the movement of the ankle joint.
4, knee flexion functional exercise: flexion exercise from 2-7 days after surgery, recommended “sitting against the wall method”, specifically: sitting on a chair, the affected foot against the wall, move the chair forward, the affected foot to maintain against the wall, to achieve the purpose of flexion of the knee joint. After the joint flexion reaches 100°, use the “two hands hold the leg method”, specifically: their own hands hold the calf backward pressure. 1 week to 90°, 2 weeks to 120°, and then maintain 120°, 8 weeks after the 120°, 12 weeks after the gradual attainment of normal flexion! Exercise 3 times a day for 10-15 minutes each time, ice for 10-15 minutes after the exercise, and the brace is adjusted back to 0° position.
In clinical practice, some patients have the misconception that the more flexible the flexion mobility is, the better. In fact, fixation is definitely best for ligament healing, but prolonged fixation has too great an effect on joint movement, so the goal of early functional exercise is to find a compromise balance between reducing interference with ligament healing and avoiding joint stiffness.
Note: (1) Since I personally use anatomical reconstruction method for most of my current ACL reconstruction, there are still many doctors who are using the original over-the-top method of positioning. If the femoral tunnel is positioned by the over-the-top method, a slower rehabilitation process is recommended, as determined by your surgeon.
(2) If meniscal sutures are performed at the same time, the flexion progress should be slower, depending on the size of the meniscal fissure, suture material and stability, etc. Please consult your surgeon for advice.
5, quadriceps strength training: 8 weeks under the protection of the brace to perform straight leg raising training, the method is to try to flex the ankle joint, the knee joint to try to straighten, lower limb raised from the bed surface about 30cm, adhere to until fatigue, step by step, day by day increase. The exercise is divided into prone position and sitting position, it is recommended that about 70% of the movements are done in sitting position and about 30% of the movements are done in prone position. 8 weeks later, remove the brace exercise, if you can persist for a period of time (about 5 minutes) at a time, you can carry out load straight leg raising training. 10-12 weeks later, you can gradually carry out squatting horse stance training according to individual strength. 3 months later, gradually carry out N rope muscle strength training.
6, outpatient review time: 10 to 14 days after surgery to remove the stitches, 3 weeks, 8 weeks, 12 weeks, six months, 1-2 years outpatient review. If there are any special changes in the condition, outpatient examination will be conducted at any time.
7.Work and exercise recovery: According to the nature and intensity of work, the time to resume work after surgery is different. Generally speaking, simple office work can be done after 4 weeks of post-operative de-inflection. For activities of greater intensity such as business trips, it is recommended that more than 3 months after surgery. In 6 months after surgery, after 4-6 weeks of adaptive training for various sports based on the above strict rehabilitation training, gradually resume jogging, cycling and other sports. Generally speaking, muscle strength and various coordination abilities can be gradually restored after 1 year, and most ball sports need more than 1 year to be performed.
Postoperative rehabilitation after posterior cruciate ligament reconstruction
With the current technical means, the effect of posterior cruciate ligament reconstruction surgery cannot reach the level of anterior cruciate ligament reconstruction. The main reason for this is that the posterior cruciate ligament is posterior and is under tremendous stress in its physiological state. After posterior cruciate ligament reconstruction, there is still a more or less degree of posterior laxity in the joint, which is a technical challenge today and there is no effective way to completely solve it. Therefore, most of the literature advocates that after posterior cruciate ligament reconstruction, the rehabilitation process must be extended appropriately to reduce the tensile stress on the ligament.
1, crutches and brace use time: postoperative turntable brace fixed for 3 months, after 8 weeks, except when walking, the rest of the time can remove the brace; crutches need 10 weeks.
2, weight-bearing requirements: 4 weeks after surgery, the affected limb is not weight-bearing, can support the crutches down; 6 weeks to start partial weight-bearing, 8 weeks full weight-bearing. Deep squatting is prohibited within six months.
3, knee flexion functional exercise: flexion exercise from 1 week postoperative exercise, exercise method as above. It is required to reach 90° at 4 weeks, 110° at 8 weeks, 120° after 8 weeks, and gradually reach normal flexion after 12 weeks! Exercise 3 times a day, 10-15 minutes each time, ice packs for 10-15 minutes after the exercise, and the brace is adjusted back to the original degree.
4.Extension training: post-operative brace fixed at 20° of flexion, no knee hyperextension practice within 6 weeks, straightening practice from 6 weeks, straightening to 0° in 8 weeks, full straightening in 10 weeks.
5. Quadriceps strength training, same method as above.
6.The stitches will be removed 10-14 days after surgery and reviewed at 3 weeks, 8 weeks, 12 weeks, 6 months and 2 years on an outpatient basis. If there are any special changes in the condition, outpatient examination will be conducted at any time.
7, work and sports recovery: compared with the ACL, the posterior cruciate ligament is stronger, and in order to reduce the factors that lead to laxity such as tension and ligament creep, it is recommended to carry out various activities 1-2 months later than after ACL reconstruction.