1. This plan should be implemented under the guidance of an orthopedic surgeon. A conventional treatment plan is provided here. As each patient’s condition is different, the specific implementation should be combined with the patient’s specific situation to develop a personalized rehabilitation program.
2.The purpose of rehabilitation after ACL surgery is mainly for: proprioception, joint stability. Liu Jinsong, Department of Arthroscopy and Sports Medicine, Orthopaedic and Traumatology Hospital, Chinese Academy of Traditional Chinese Medicine 3. 6 weeks of brace wear after ACL reconstruction, in addition to knee rehabilitation, active activities of adjacent joints should be started as early as possible.
4. The presence of pain during rehabilitation exercises is unavoidable. If the pain subsides or disappears within half an hour of exercise cessation, it will not cause damage to the tissue and should be tolerated.
5. Muscle strength exercises should be carried out throughout the rehabilitation program. Each exercise should be performed until the muscles feel sore and fatigued, and then proceed to the next group after sufficient rest. The improvement of muscle strength is a key factor for joint stability and must be taken seriously.
6. Swelling of the joint will accompany the whole exercise process 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 review should be made.
7.Ice packs should be applied for 15-20 minutes immediately after the functional exercise. If you feel swelling, pain and fever in the joint, you can apply ice again, 2-3 times a day.
8.The brace should be a long-legged straight brace or a chuck brace, which is generally worn 4-6W after surgery.
9.If there is any discomfort in the training, please stop the training immediately and ask the therapist before proceeding.
Training.
Phase I: 1-7 days after surgery (postoperative edema period).
Purpose
1.Non-weight-bearing.
2.Practice mobility.
3.Practice proprioception.
4.Promote blood circulation.
5.Static muscle strength exercises.
6.Prevent muscle atrophy.
1.1-2 days after surgery.
1) Brace – locked in 0° extension position. With brace for 4 – 6 weeks, walking – double crutches; no weight bearing.
2)Exercises.
① Ankle pump: forceful, slow, full range ankle plantar flexion and dorsiflexion promotes blood circulation, eliminates swelling, and is important to prevent venous thrombosis. 1 set of 1-2 sets of 20 once a day for 4 hours.
② Knee ROM training.
CAM is performed by driving the affected limb with the healthy limb to straighten the passive knee to 0° (patients with poor physical strength and those with the possibility of joint adhesions can be performed using CPM, or static exercises).
N cord muscle pulling training: 1-2 sets of 5 sets 4 times a day.
③ Muscle strength training: 1-2 sets of 20 each time, once every 4 hours daily.
Isometric training.
1) Lie flat on bed, static exercise.
2) Biodex equipment quadriceps isometric contraction, N cord muscle isometric contraction exercises.
Isotonic training.
Straight leg raise exercise: straight leg raise after knee extension to heel 15M above the bed.
Passive knee extension to 0°.
Quadriceps isometric contraction Straight leg raise exercise.
④ Electrotherapy: 1-2 times a day for half an hour to an hour each time.
Prevention of muscle atrophy: electrical stimulation.
Analgesia: TENS.
⑤ Ice packs: 15 minutes each time, temperature 0-4 degrees.
2. 3 days after surgery.
1) Brace – locked in 0° extension position.
Walking – crutches; non-weight bearing exercises.
2)Exercises.
① Ankle pump exercises: forceful, slow, full range ankle plantar flexion and dorsiflexion can promote blood circulation and eliminate swelling, which is important to prevent venous thrombosis.
② proprioceptive training: CAM 4 times a day for 15 minutes each time ③ loosening patella: 1-2 sets of 4 directions for 15 sets each time 4 times a day
④ Knee ROM training: passive closed chain knee flexion training: 0°-90° CPM : 1-2 times daily for 1 hour each time
CAM : 4 times a day for 15 minutes each time.
Foot slide training along the wall: 4 times a day for 1 hour.
Supine closed chain training: 4 times a day for 1 hour each time.
Foot slide training along the wall Supine closed chain training.
Sitting in a chair with the affected foot on the floor and the healthy foot helping the patient to bend the leg at 90°: 4 times a day, 5 times each time.
Biodex3 training: passive mode ⑤ muscle training: 4 times a day, 1-2 sets of 20 each, with 2 minutes rest in between.
A. Isometric training.
l Isometric co-contraction of quadriceps and N cord muscles in supine position l Flexion isometric training; extension isometric training; inversion, extension isometric training.
lBiodex 3 training: multi-point isometric training.
B. Isometric training.
Lateral leg lift exercises.
Posterior extension exercises.
Moflex equipment training.
Hip inversion exercises.
Moflex equipment exercises.
Hip abduction exercises.
Posterior extension exercises.
3) Electrotherapy.
Prevention of muscle atrophy: electrical stimulation.
Analgesia: TENS.
4)Ice or cold air therapy.
3. 4-14 days after surgery.
Exercises same as postoperative day 3, add prone position knee flexion on postoperative day 8.
Phase 2 postoperative 2-3W (maximizing protection phase).
Criteria for entering phase 2 training.
Good quadriceps control.
Full passive knee extension.
Passive ROM 0°-90°.
Good patellofemoral mobility.
Little joint ooze.
Objectives of phase 2 training.
1. Practice active knee motion.
2. Increase muscle strength training.
3. Continue proprioceptive training.
Training.
1. Second week postoperatively.
1) Continue the above exercises.
2) Terminal knee extension muscle strength exercises: 1-2 sets of 20 each, 4 times a day, with 2 minutes rest between sets.
3) Moflex device: ankle plantarflexion resistance training.
4) Knee ROM training: Passive knee flexion 0-100° Active knee flexion 0-80°.
Foot slide training along the wall.
CAM training: 4-6 times a day for 30-45 minutes each time.
Biodex exercises: 1 set once a day.
Active-assisted ROM exercises.
Quadriceps multi-point isometric strength training.
N cord muscle multi-point isometric strength training.
2. Third postoperative week.
1)Continue the above exercises.
2)Knee ROM training: passive knee flexion 0-105° active knee flexion 0-90°.
CAM training: 6 times a day for 40-60 minutes each time.
Prone knee flexion exercises.
3) Intensive plyometric training: 4 times a day, 2 sets of 20 each.
Standing position: Straight leg raise training, hook leg training.
Seated position: Theraband knee flexion.
Prone knee flexion exercise.
Moflex equipment training.
Prone knee flexion exercise Standing position: Straight leg raise training.
Phase 3: Controlled walking phase (4-6 weeks postoperatively).
Progression to stage 3 criteria.
Active ROM 0-90°.
Small amount of exudation.
Phase 3 training objectives.
1. No restriction of active knee movement.
2. Increase muscle strength around the knee joint.
3. Increase knee stability.
Training.
1. Fourth week after surgery.
1)Patellar release.
2) Knee ROM training.
Passive knee ROM: 0° – 105°, active ROM: 0° – 90°.
Knee flexion in prone position.
Standing position knee flexion.
3) Plyometric training.
Molfex straight leg raise (gradually increase from 0, 5 lbs. to 5 lbs.).
Moflex hip abduction, adduction and posterior extension resistance training (from 0, 5 lbs. to 5 lbs. gradually).
Micro-squat training (0-30°) for 30 seconds, 20 repetitions, 3 sets.
Biodex exercises.
Active-assisted ROM exercises.
Quadriceps multi-point isometric strength training.
Strength training for N cord muscle multi-point isometric.
4) Weight-bearing and balance training: training under the guidance of therapist.
Partial weight-bearing training for the affected limb in the parallel bar (25% to start), weight transfer training from front to back and from side to side.
5)Walking in the swimming pool for 20 minutes.
6)Power bicycle training for 15 minutes.
7)Micro squat training Lateral straddle training.
2. 5-6 weeks after surgery.
1) Knee ROM training: CAM training.
Passive knee ROM: 0° – 125°, active ROM: 0° – 105°.
2) Muscle training.
Moflex equipment N rope muscle resistance training.
3) Weight-bearing and balance training.
Partial weight-bearing training of the affected limb within the parallel bar (50%-100%), left-right and anterior-posterior transfer training of the center of gravity.
4) Forward-backward and side-to-side stride training: can be performed with the assistance of Moflex equipment.
5) Single crutch walking training.
6) Kardio power bike training 15 min.
Phase 4 7-12 weeks postoperative (intermediate protection phase).
Progression to stage 4 criteria.
Active ROM 0°-125°.
Quadriceps strength deficit ≤ 40%.
N cord muscle strength deficit ≤ 20%.
No change in KT score (+2 or less at 20 lbs).
Phase 4 Training Objectives.
1. Patient’s independent weight-bearing walking.
2. The patient’s muscle strength and stability reaches 70% of normal standards.
Training.
At this stage the patient walks off the crutches.
1. Warm-up: Kardio power bike for 15 minutes.
2. Patellar release.
3. Knee ROM training.
CAM training.
Passive knee ROM: 0° – 140°, active ROM: 0° – 120°.
4. Strength training.
Single leg heel lift training: 20pcs/group.
Power bike resistance training: 15 minutes.
Squat training: 20pcs/group, 3 groups/day.
Balance training.
Training on hard ground, training on stability training mat, balance board training.
Multi-hip hip trainer resistance training: forward flexion, back extension, abduction, adduction.
Stair Leg Press Multi-Hip.
Biodex isometric endurance training (quadriceps).
Moflex equipment training (Multi-Hip training is also available).
5. Proprioceptive training (stability training).
Center of gravity transfer training.
Up and down step training.
CAM training.
Biodex exercises (closed chain exercises).
Backward walking.
6. Gait training.
Up and down step training, lateral up and down step training.
Stage 5 Return to active activity stage (13-24w).
Criteria for progression to stage 4.
Increase in strength, endurance.
Begin preparation for functional activities.
No change on KT2000 test.
Isometric test: (16 weeks postoperative, -2 velocities, 60°, 180°).
Quadriceps deficit ≤ 35%.
N cord muscle deficit ≤ 6%.
Phase 5 training objectives.
1.The patient walked a certain distance completely independently.
2.The patient can go up and down certain steps completely independently.
3.The patient’s muscle strength and stability reach 85~90% of the normal standard.
Training.
1.Adaptive training.
Power bicycle.
2.Strength and coordination training.
Isotonic training: continue open chain and closed chain training. Progressive resistance training with resistance maintained at 70-75% of seated knee extension maximum.
Moflex training.
Kardio Stairmaster training.
Compass Leg press training.
Compass Multi-hip hip trainer training.
Isometric training: Biodex start 60° and 180° strength, endurance training Moflex training.
3. Balance and stability training.
Biodex balance training.
Plyometrics training: Jump up and down exercises, lateral straddle exercises.
Trampline balance and proprioceptive training.
4.Treadmill walking training.
5.Flexibility training.
Knee loop exercises.
Lateral movement training.
Lateral or backward running, vertical jumping, rope skipping, figure 8 running, emergency stop-and-go training.
If the H/Q ratio reaches 80% in the isokinetic evaluation, you can train professional sports activities.
The above training plan is for reference only! Be sure to train under the guidance of your doctor or therapist!