Let’s talk about rehabilitation. For orthopedic surgeons, how to do postoperative rehabilitation is a constant topic to ensure the efficacy of surgery. In China, the development of post-operative rehabilitation medicine is limited for various reasons. The current situation is that many hospitals in the country have no specialist rehabilitation doctors, and post-operative rehabilitation only relies on surgeons. The following is a combination of post-operative rehabilitation programs for ACL reconstruction used in many hospitals in China, for your reference.
Within 1 week after surgery
Complete passive extension of the knee joint
Control of exudation
Quadriceps retraining
Active knee flexion at 90 degrees
Lower extremity functional exercise machine (CPM)
Avoid active knee extension last 20 degrees
In the early stages of functional exercises, static exercises are the mainstay because of the low muscle strength level, the more obvious inflammatory reaction of the tissues and the fragility of the reconstructed ligaments.
Correct body position
Ankle pump exercises
Quadriceps isometric contraction exercises: i.e. thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (More than 500 times/day) Place your hands on your thighs, especially on the slightly inner side of the lower thighs, to experience the contraction of the medial femoral muscles, making sure that each contraction is clearly felt. This exercise has another significance: the contraction of the muscle can trigger the movement of the patellofemoral joint, thus maintaining the flexibility of the patella after the injury, which has a greater effect on preventing stubborn adhesions of the joint, and at the same time can ensure the normal elasticity of the muscle, which has a greater effect on the flexibility of the whole knee joint.
Isometric exercises for the N cord muscle
Isometric exercises for quadriceps and N cord muscles at the same time
Straight leg raise exercise: sitting or lying position, thigh muscles fully contracted, after locking the knee joint, straight leg raise to the heel 15-30M from the bed, hold until exhaustion, interval 10 seconds, 10-20 times / group, 3-5 groups / day. The key to this exercise is to fully straighten the knee joint, a slight bending exercise effect is greatly reduced.
Side leg raises
Rear leg raise (brace protection)
Sitting on a chair with the knee straight or slightly bent, imagine standing up – isometric contraction of the quadriceps and N cord muscles together.
Weight-bearing exercises (brace)
Flexion exercises (self-assisted stretching in the minimally painful range), ice immediately after the exercise. (If, due to the painful effect (pain arc), nerve control over the muscles is reduced so that the muscle group controlling the movement of the joint in that range is never aroused (muscle disuse phenomenon) and cannot be trained effectively, try to perform several exercises with pain within the pain arc to arouse the movement of the relevant muscle group. At this time, care should be taken to control the pain produced during the exercise within the tolerance range, and attention should be paid to the timely application of an adequate amount of ice packs after the exercise and to give it adequate rest).
Stretching exercises balance exercises: alternately move the center of gravity left and right, front and back within the range of slight pain to start active flexion and extension exercises
Prone position “leg hook exercise”
Flexion exercises to 70°-90°
2-4 weeks after surgery
Purpose: To strengthen mobility and muscle strength exercises, improve joint control and stability, and gradually improve gait.
Resistant straight leg raise exercise: sit on the bedside (chair or apparatus), weight on the affected ankle, perform resistive knee extension exercise in the range of full extension to 70 degrees, with a fast rhythm – a slight pause of 2 seconds – slow down, the weight should be sufficient fatigue and no pain in the range of 10-15 repetitions, if fatigue and If fatigue and pain are in conflict, give priority to pain control and extend the pause time in the movement to enhance the training effect.
Rest half a minute for each 10-15 reps, 60-90 consecutive sets, 2 sets of days. This exercise can also be performed on the healthy side, but should pay attention to the appropriate increase in the range and load to differentiate. If the active extension of the affected limb is limited, emphasis should be placed on strengthening the resistance knee extension exercises in the range from hyperextension to 30 degrees of knee flexion, strengthening the medial femoral muscles, with no change in the standard of movement. In fact, the last 30 degrees of joint control is the most significant in daily work sports, and the strength of the medial femoral muscle in this area accounts for more than half of the strength of the entire muscle group, so in most cases the focus should be on exercises in this range of motion.
Passive full extension weight shift to full weight bearing on the affected limb, transition to single footed stance
Squatting against the wall: back against the wall, both knees and shoulder width, toes forward, squatting to the tip of the knee and toe line perpendicular to the ground, the center of gravity on the affected foot, self-control squatting depth, the basic control can be in about 2 minutes to reach the level of full fatigue, the interval does not exceed 10 seconds, 5-10 consecutive groups, 2 groups of days. If you want to increase the difficulty, you can place a soft ball (not less than the size of a volleyball) between your back and the wall, and perform the same standard exercises. This method is suitable for all patients who have no limitations for weight bearing on the lower limb. If there is cartilage damage in the affected limb and pain will occur during the exercise, the damage interval can be avoided by fine-tuning the angle up and down to try to keep the exercise from occurring within the pain arc. If the strength reaches a certain level, you can increase the difficulty and the fun of the exercise by changing the way you squat, in order to strengthen the effect and practicality of the exercise.
One-footed support (golden chicken independence): the affected side of one limb fully straight stand, thigh muscles fully contracted, the knee joint “back to the top”, chest and abdomen, buttocks and head, to maintain balance, when you reach a stable stand 1-2 minutes without falling, you can try to take off the abduction. Generally stand for 5 minutes / time, rest interval 10 seconds, 2-3 times / group, 1-2 groups / day. When standing for more than 5 minutes and still be able to ensure a smooth body, you can transfer to the balance board to continue this exercise, the standard remains the same.
It is recommended that the balance board can be made in the following way: 4-5 empty mineral water bottles with tightened caps, tied with cloth into a row, placed on the ground, it becomes a single foot balance board, bipedal use to make two can. Just on to pay attention to safety, to prevent falls, strength can also be practiced on the board 0-45 ° half squat. This method is suitable for those who do not have any contraindications to lower limb weight-bearing, practice should try to ensure pain-free.
Standing on one foot for 1 minute, you can start walking with crutches
Active knee flexion and extension exercises
Heel lift exercises
Passive flexion to 110-120°
5 weeks – 3 months postoperatively
Purpose: To strengthen the joint mobility to the same level as the healthy side. Strengthen muscle strength and improve joint stability. To restore the ability to perform all activities of daily life. Absolute strength exercises are the main focus. Open chain muscle training: quadriceps trainer, sandbag straight leg raise bike in all directions, single leg squat, seated knee hold
After 4 months
Objective: To restore all activities of daily life, to strengthen muscle strength and joint stability, to gradually resume sports, to improve the maximum strength at a later stage, and to choose large-load training, during this period the reconstructed ligaments are not strong enough, so the exercises should be gradual, not forced or blindly adventurous. It is important to strengthen the muscles to ensure the stability and safety of the knee joint in sports.
Resistance Flexion: Lie prone on the bed with weights or leather straps around the ankle on the affected side and perform the maximum range of resistance flexion with the same weights, movement specifications, and number of exercises as the “resistance knee extension” movement above. The purpose of this exercise is to strengthen the posterior thigh muscles (N cord), which are antagonists of the anterior quadriceps, and play an important role in maintaining the balance of the joint and the controllability of the joint movement, so it is important to pay attention to this exercise.
The presence of pain during functional exercises is unavoidable. The improvement of muscle strength is a key factor in joint stability and must be practiced carefully. Except for the braking protection of the operated limb, the rest of the body parts (should be practiced as much as possible to ensure physical fitness, improve the overall level of circulatory metabolism, and promote the recovery of local mobility of the operated area Ice packs are given for 15-20 minutes immediately after the exercise. If you feel swelling, pain and heat in the joint is obvious, you can apply ice again. Swelling of the joint will accompany the whole exercise process, and it is normal that the swelling does not increase with the increase of angle exercise and activity, until the angle and muscle strength basically return to normal swelling will gradually subside. Sudden increase of swelling should adjust the exercise and reduce the amount of activity, and in case of seriousness, timely follow-up should be made.