Post-operative rehabilitation process after ACL reconstruction
I. Initial period (0-2 weeks after surgery)
Purpose: To reduce pain and joint swelling; early muscle strength exercises and joint mobility exercises to prevent adhesions and muscle atrophy.
The initial stage of exercises is mainly static exercises (joint inactivity, maintaining a certain posture until muscle fatigue). Gradually increase the small load of endurance exercises, that is, choose a light load (to complete 30 times the amount of fatigue of the movement that the load), 30 times / group, 30 seconds rest between groups, 2-4 groups of continuous practice until fatigue.
Do not walk too much! Walking should not be used as an exercise method! Otherwise, it is very easy to cause joint swelling and fluid accumulation, which will affect functional recovery and tissue healing.
1. On the day of surgery.
After the anesthesia subsides, start to move your toes and ankle; if the pain is not obvious, try to contract the quadriceps.
2.The first day after surgery: 24 hours after surgery, you can walk with your feet without touching the ground by holding the double crutches
(1) Ankle pump – forcefully, slowly, full range of flexion and extension of the ankle joint, as much as possible. (It is important to promote circulation, reduce swelling and prevent deep vein thrombosis.
(2) Quadriceps isometric exercises, do as many as possible without increasing pain. (>500 reps/day)
(3) N cord muscle isometric exercise, the affected leg is placed on a pillow, and the padded pillow is pressed down hard to tense and relax the posterior thigh muscles. Requirements as above, more than 500 times / day.
(4) Correct position placement: the affected leg is elevated on the pillow, the toe is directly above, not crooked to the side, the knee joint should be vacated below, and the pillow should not be used to cushion the leg into a slightly bent position. If the pain is unbearable, the leg should be placed in a comfortable position under the guidance of a physician.
(5) Patients with reconstruction of anterior cruciate ligament by thin femoral muscle and semitendinosus muscle, start to try straight leg lift: straight leg lift after knee extension until heel is 15M from bed, hold until exhaustion. 10 times/group, 2-3 groups/day.
(6) Patients with patellar tendon (bone-tendon-bone) reconstruction of anterior cruciate ligament, if the pain at the patellar tendon incision is more obvious, the above exercises can be performed again in 2-3 days, and the number of times is reduced by half.
3. Postoperative day 2: remove the drainage tube as appropriate
(1) Continue the above exercises.
(2) Change the ankle pump to anti-gravity exercise (can be assisted by others or hold the thigh with hands). This can be done after each time you get out of bed to prevent swelling.
(3) Begin lateral leg raises, 30 reps/set, 2-4 sets/day, with 30 seconds rest between sets.
(4) Start posterior leg raising exercises, lying prone (face down on the bed), with the affected leg straightened and raised backward until the toe is 5 cm above the bed surface for one time, 30 times/group, 2-4 groups/day, with 30 seconds rest between groups.
4.Post-operative day 3: Start joint mobility exercises as decided by the doctor.
(1) Continue the above exercises.
(2) Weight bearing and balance – separate the feet left and right under protection, alternately move the center of gravity left and right within the range of slight pain, and strive to achieve full weight bearing standing on one leg, 5 minutes/time, 2 times/day; separate the feet front and back, move the center of gravity, and strive to achieve full weight bearing standing on one leg.
(3) Start flexion exercises (within the range of slight pain, early exercises still have some risk.)
(4) Immediately after the flexion exercise, apply ice for about 20 minutes.
(5) Extension exercises: remove the splint, put a pillow at the heel, make the affected leg leave the bed completely, and relax the muscles to make the knee joint extend naturally. 30 minutes/time, 1-2 times/day. The time interval with the flexion exercise is as far as possible.
5. Day 4 after surgery.
(1) Continue the above exercises.
(2) Strengthen the weight-bearing and balance exercises, gradually until you can stand on one foot with the affected leg. If this can be done easily, start walking with a single crutch (supported on the healthy side).
(3) Flexion exercises to 0°-60° range.
6. Postoperative day 5.
(1) Continue and strengthen the above exercises.
(2) Flexion exercises to 70°-80°, and active flexion and extension exercises can be started. After the first 5 times, gradually increase to 10-20 times and apply ice after training.
7. 1-2 weeks after surgery.
(1) Active flexion up to 90°.
(2) Adjust the brace to 30°-50° range of motion according to the degree of knee stability.
(3) Patellar tendon (bone-tendon-bone) reconstruction of the anterior cruciate ligament patients, start the prone position “hook leg exercises”, 10 times / group, 2-4 groups / day. Use sandbag as the load and perform within the range of motion of the splint, and apply ice immediately after the exercise. For patients with anterior cruciate ligament reconstruction of thin femoral muscle and semitendinosus muscle, “leg hooking” exercises in standing position should be started 4-6 weeks after surgery.
Early stage: (2-4 weeks after surgery)
Purpose: To strengthen joint mobility and muscle strength exercises: to improve joint control and stability; to gradually improve gait.
1.2 weeks after surgery.
(1) Passive flexion to 90-100°.
(2) Strengthen muscle strength exercises. (Straight leg lift can be weighted on the thigh side as a load.)
(3) If you can stand on one foot for 1 minute, you can walk with a single crutch, and you can walk indoors with no crutch.
(4) Stretch up to basically the same as the healthy side.
(5) Start to practice flexion on your own with guidance.
(6) Gradually adjust the brace to 0°-70° range of flexion and extension, and increase the angle every 3-5 days, and adjust to 110° after 4 weeks postoperatively. If the joint instability during walking and weight-bearing is obvious after the adjustment, the angle will be reduced back to the pre-adjustment angle.
2.3 weeks after surgery.
(1) Passive flexion to 100-110°.
(2) Strengthen active flexion and extension exercises and strengthen muscle strength exercises.
(3) Start to try to walk off the crutches.
(4) Patellar tendon (bone-tendon-bone) reconstruction of the anterior cruciate ligament patients, start standing “hook leg” exercises. 30 times/group, 4 groups/day.
3. 4 weeks after surgery.
(1) Sleep without brace.
(2) Passive flexion up to 110-120°.
(3) Adjust the brace to 0°-110° of flexion and extension.
(4) Begin anterior-posterior and lateral straddle exercises. Front straddle exercise: the affected leg straddles forward, then shifts the weight forward after, lateral straddle exercise in a similar way, 30 times/group, 4 groups/day.
(5) static squat exercises back against the wall, feet shoulder-width apart, toes and knees are forward, not “inside and outside the eight”, with the power to gradually increase the angle of squatting (less than 90 °), 2 minutes / time, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day.
(6) Strive to achieve normal gait walking.
III. Mid-term: (5 weeks-3 months after surgery)
Purpose: Intensify joint mobility training to the same level as the healthy side. Strengthen muscle strength training and improve joint stability. Restore the ability to perform activities of daily living.
With the improvement of muscle strength level, absolute strength exercises are the main focus in the middle stage. Choose a medium load (the amount of load to complete 20 movements to feel fatigue), 20 times / group, 2-4 sets of continuous exercises, rest 60 seconds between groups, until fatigue.
1.5 weeks after surgery.
(1) Passive flexion up to 120-130°.
(2) Begin knee exercises with the affected leg in a 45° position in semi-squat flexion and extension. The affected leg stands on one leg with the upper body straight, slowly squats to 450 degrees of flexion, and then slowly stretches until fully straightened. 20-30 times/group, 30 seconds interval between groups, 2-4 times/day.
(3) Stationary bicycle exercises, no load to light load. 30 minutes/set, 2 times/day.
2.8-10 weeks after surgery.
(1) Passive flexion angle gradually to the same as the healthy side.
(2) After the “seated knee hold” is identical to the healthy leg, start to gradually protect the lower full squat.
(3) Strengthen the muscle strength, use the leather band for quadriceps, N cord muscle and other muscle strength training.
3.10 weeks-3 months after surgery.
(1) Active flexion and extension of the knee angle is basically the same as the healthy side, and there is no obvious pain.
(2) Daily prone position flexion so that the heel touches the hip, continuous stretching for 10 minutes/time.
(3) Begin kneeling exercises after the sitting knee angle is exactly the same as the healthy side.
(4) Begin pedaling exercises.
(5) 3 months after surgery, if possible, perform various functional tests to provide an objective basis for the next stage of daily life and normal exercise.
IV. Late stage: (4 months-6 months after surgery)
Purpose: To fully resume all activities of daily life. Strengthen muscle strength and joint stability training. Gradually resume sports.
In the later stage, increase the maximum strength, choose a large load of 70% 1RM (the amount of load to complete 12 movements that feel fatigue), 8-12 times / group, 2-4 groups of continuous exercises, rest 90 seconds between groups, until fatigue.
(1) Start the knee loop exercise.
(2) Start jumping up and down exercises.
(3) Begin lateral straddle exercise.
(4) Start swimming (breaststroke is prohibited in the early stage). Jump rope and jogging.
(5) The athlete begins specific exercises for the base movements.
During this period the reconstructed ligaments are not strong enough, so the exercises should be done gradually and not reluctantly or blindly. It is important to strengthen the muscles to ensure the stability and safety of the knee joint in sports and to wear a knee brace for protection.
V. Recovery period: (7 months – 1 year after surgery)
Full return to sports or strenuous activities. Strengthen the muscle strength and stability of the joint during running and jumping. Gradually resume strenuous activities or special training.