ACL injury is one of the most common and serious sports injuries. ACL tears cause knee instability, and improper treatment will cause severe knee dysfunction. Because the injury is violent and often combined with other major structural injuries, improper diagnosis and treatment will delay treatment and cause functional instability, resulting in a knee that cannot meet the needs of daily life and sports, and can lead to a series of sequelae of the knee, so surgery should be performed to reconstruct the ligament and its function. Arthroscopic technology is the first minimally invasive technology used in orthopedics. Since its application in the clinic, it has greatly improved the diagnosis of joint disease and has performed many intra-articular lesions that are difficult to perform with conventional surgery. It has not only expanded from the knee joint alone at its inception to include the shoulder, elbow, wrist, hip, ankle and even interphalangeal joints, but has also evolved from the simple management of meniscal injuries and synovial disease to the ability to perform meniscal transplants, anterior and posterior cruciate ligament reconstructions and cartilage defect transplants.
The rehabilitation plan after ACL reconstruction surgery and meniscus repair surgery.
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 (complete 30 movements that is the amount of fatigue), 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 anesthesia subsides, start to move your toes and ankles; if 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 presses down hard on the padded pillow to make the posterior thigh muscle tense and relax. Requirements as above, more than 500 times / day.
(4) Correct body 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, no pillow should 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 exercises (can be assisted by others or hold the thigh with hands). This can be done after each bedtime to prevent swelling.
(3) Begin lateral leg raise exercises, 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: According to the situation, the doctor will decide to start joint mobility exercises
(1) Continue the above exercises.
(2) Weight-bearing and balance – separate both 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 both feet back and forth, move the center of gravity, and strive to achieve full weight-bearing standing on one leg.
(3) Start flexion exercises (within the range of minimal pain, early exercises are still dangerous).
(4) Immediately after the flexion exercise, apply ice for about 20 minutes.
(5) Extension exercises: remove the splint, put a pillow at the heel, keep the affected leg completely off the bed, and relax the muscles so that the knee joint extends naturally. 30 minutes/time, 1-2 times/day. The time interval with flexion exercise is as far as possible.
5. Day 4 postoperative.
(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) Adjustment of the brace to 30°-50° range of motion depending on 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.
2. 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 loaded with a weight on the thigh side).
(3) Walking with one crutch if able to stand on one foot for 1 minute, and walking indoors with the crutch removed.
(4) Stretch up to basically the same as the healthy side.
(5) Begin to practice flexion on their own with guidance.
(6) Gradually adjust the brace to 0°-70° range of flexion and extension, and increase the angle every 3-5 days, to 110° at 4 weeks after surgery.
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. The exercises should be performed statically, with the knee flexed to a pain-free angle for 10-15 seconds. 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) Start anterior-posterior and lateral straddling exercises. (4) Begin anterior and lateral straddle exercises. Posterior and lateral straddle exercises in a similar manner, 30 times/group, 4 groups/day.
(5) static squat exercises: back against the wall, feet shoulder-width apart, toes and knees forward, no “internal and external figure of eight”, gradually increase the angle of squatting (less than 90 °) with increasing strength, 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° single leg 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. Requires slow, hard, controlled (no swaying). 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, begin 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 postoperatively.
(1) Active flexion and extension of the knee at basically the same angle as the healthy side, and without significant pain.
(2) Daily prone position flexion so that the heel touches the hip and continuous stretching for 10 minutes/time.
(3) Begin kneeling exercises after holding the knee at exactly the same angle as the healthy side in the seated position.
(4) Begin pedaling exercises.
(5) 3 months after surgery, if possible, functional tests can be performed to provide an objective basis for the next stage of daily life and normal exercise.
Fourth, the 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) Start lateral straddle exercise.
(4) Start swimming (breaststroke is prohibited early on), rope skipping and jogging.
(5) The athlete starts special 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.