I ACL reconstruction post-operative rehabilitation program (0-2 weeks).
1. Objectives.
①Wear a brace to keep the knee joint straight and locked at 0°, emphasizing passive extension. Liu Gang, Department of Rehabilitation, The Third Affiliated Hospital of Southern Medical University ② Control postoperative pain and swelling.
③After rehabilitation exercises, active knee flexion R0M up to 0°-90° ④Early progressive weight-bearing.
⑤Prevent quadriceps atrophy.
⑥Complete the home training treatment plan independently.
2. Precautions.
①Avoid active knee extension between 40°-0°, you can extend the knee with the help of the healthy side limb.
②The brace should be locked at 0° when walking.
③Avoid applying heat to prevent joint swelling and apply cold compresses promptly after rehabilitation.
④Avoid standing and walking for a long time, no more than 30 minutes at a time.
3. Treatment measures.
①Place a towel roll on the ankle joint to keep the knee joint extended and promote the elimination of postoperative edema.
②Low frequency electrical stimulation treatment for quadriceps muscle.
③Straight leg raising exercises (SLR) (all directions): the leg of the affected lower limb is raised about 30-40° for strengthening exercises of lower limb muscle strength and endurance to promote the recovery of patellar ligament injury and the recovery of knee joint stability. At the same time, you can do hip joint abduction and adduction exercises under the leg elevation. The movement can also be performed under suspension.
④Progressive resistance training of the hip: it is recommended to use elastic band for training.
⑤ Patellar release: maintain patellar mobility.
⑥Active flexion/active extension exercises with full process assistance.
(vii) Brace locking at 0°, using a cane, progressive partial weight bearing of the affected limb, not to exceed 1/2 of the body weight.
⑧ proprioceptive training (bilateral weight-bearing).
⑨Sliding wall stirrup exercise, using the healthy side foot to assist the affected limb for knee movement, keeping the joint mobility at 70°-5°, keeping the palm of the foot close to the wall during the whole process.
4. Post-treatment cold therapy.
Cold therapy is performed promptly after each rehab session, 20-30 minutes each time.
II. Post-operative rehabilitation plan for anterior cruciate ligament (ACL) reconstruction (2-6 weeks).
1. Objectives.
(1) ROM up to 0°-125°.
(2) Good patellar mobility.
(3) Joint control in the category of mild swelling.
(4) Return to normal gait (no pain).
(5) Step up 20cm high ladder with no pain and good control.
2.Cautions.
(1) Avoid repeated descents until adequate quadriceps control and lower extremity alignment is restored.
(2) Avoid pain during training and functional activities.
3.Treatment measures.
(1) Progressive weight bearing/weight bearing within tolerable range when quadriceps control is good (no pain or delay in straight leg lift) with angle opening to 0 degrees – 50 degrees.
(2) When walking is pain-free, remove the crutches and you can practice on a soft couch to strengthen stability and balance sensory exercises and enhance proprioceptive input.
(3) Change the brace (off-the-shelf brace, patellar knee brace, etc.) as prescribed by the surgeon.
(4) If the joint mobility is greater than 115 degrees, standard bicycle exercises can be performed.
(5) Pedaling exercises (80°-0°).
(6) Small range of static squats/weight shifts.
(7) Proprioceptive training (biomechanical ankle platform system/healthy side elastic band exercises).
(8) Begin forward step-up exercises.
(9) Underwater training (gait training) if wound is good.
(10) Progressive resistance lower straight leg raise exercises.
(11) N cord muscle/gastrocnemius flexibility training (heel lift, alternate tiptoe)
(12) Progressive resistance exercises for hip/N-rope muscles.
(13) Active knee flexion to 40°.
III. Post-operative rehabilitation plan for anterior cruciate ligament (ACL) reconstruction (6-14 weeks).
1. Objectives.
(1) Restore normal R0M.
(2) Ability to step down from a 20cm high step without pain and with good control of the lower extremity.
(3) Improve ADL endurance.
(4) Improvement of lower limb flexibility.
(5) Protect the patellofemoral joint.
2.Cautions.
(1) Avoid pain during training and functional activities.
(2) Avoid running and sports training until sufficient muscle strength is available and the operator allows it.
3.Treatment measures.
(1) Progressive static squatting exercises.
(2) Begin step-down exercises.
(3) Pedaling exercises.
(4) Lunge exercises.
(5) 90°-40° isometric knee extension (closed chain exercises preferred).
(6) Advanced (interference) proprioceptive training.
(7) Flexibility training (exercise band).
(8) Backward walking or backward running bicycle exercises.
(9) Quadriceps stretching.
(10) Forward step-down test.
(11) Home rehabilitation based on assessment results.