Preface
One of the most common complications after ACL reconstruction is loss of mobility, especially limitation of extension. Limited knee extension will result in claudication, quadriceps muscle weakness, and anterior knee pain. Studies have already shown that the timing of ACL reconstructive surgery has a significant effect on postoperative knee stiffness.
The incidence of knee stiffness after ACL reconstruction is highest when the knee is swollen, painful and less mobile.
The risk of post-operative knee stiffness can be significantly reduced if surgery is delayed until the acute inflammatory phase of the knee has passed, the swelling in the joint cavity has subsided, a normal or near-normal knee range of motion is present and a normal gait is re-established.
Pre-surgical rehabilitation program
Goal: Relieve pain and swelling
Restore normal knee range of motion
Build muscle strength sufficient for a normal gait
Pre-operative psychological preparation of the patient
The acutely injured knee should be at rest with little or no knee swelling, a good range of motion, and a normal or near-normal gait for the patient prior to surgery. Before preparing for knee surgery, follow these guidelines.
Immobilize the knee joint
After an acute injury, a knee brace and crutches should be used until you regain good muscle strength in the leg. The knee brace should not be used for too long and should avoid quadriceps atrophy. Encourage the affected limb to bear as much weight as is comfortable.
Control pain and swelling.
Ice the knee joint with oral NSAIDs will help control pain and swelling.
Restore normal range of motion.
The patient should attempt to achieve full extension of the knee as quickly as possible. Examples include quadriceps isometric contraction exercises, straight leg raise exercises, etc.
Complete extension is achieved by doing the following exercises.
1. Passive knee extension.
Sit in a chair and place your heels on the edge of the bench or chair. Relax your thigh muscles and allow your knee to sink through your own weight until you reach maximum extension.
2. Heel props.
Use a rolled up towel to prop your heel up high enough to ensure your thighs are lifted. Allow the leg muscles to relax and the knee joint to straighten for a period of 10-15 minutes 3-4 times a day.
3.Suspension exercise.
Prone position with thighs hanging from the edge of the bed, allowing the legs to drop fully.
By doing the following exercises to achieve flexion
1.Passive knee flexion
Sit on the edge of the bed and let the knee bend under the influence of gravity.
2.Sliding wall is used to further increase flexion
Place the foot on the affected side on the wall and use the other leg to apply downward pressure to slide the foot off the wall by bending the knee joint.
3.Heel sliding exercise method
Bend the knee and pull the heel toward the hip and hold for 5 seconds.
Straighten the leg and slide the heel toward the distal end and hold for 5 seconds. As shown in the figure.
At a later stage of rehabilitation, i.e. holding the leg with both hands, bend the knee with force.
Muscle strength exercises
Once 100 degrees of flexion has been achieved, muscle strength exercises can begin with.
1. Stationary bicycle exercise. Use a stationary bike for 10-20 minutes twice a day to help increase muscle strength, endurance, and maintain knee mobility.
2, At this stage, swimming is another exercise that builds muscle strength and maintains your range of motion.
3, Low impact cross training, such as leg pushers.