(Before using this program to guide the exercises, you should read the entire contents carefully and execute them with your doctor’s permission) ※, Notes: 1, the methods and data provided in this program are formulated in accordance with the general routine, the specific implementation of which should be completed under the guidance of a doctor depending on their own conditions and surgical conditions. 2, functional exercises in the presence of pain, is unavoidable. If the pain subsides to the original level within half an hour of stopping the exercise, it will not cause damage to the tissues and should be tolerated. 3.Muscle strength exercises should be focused on practicing until the muscles are sore and fatigued, and then proceed to the next group after sufficient rest. The number of exercises, time and load depends on your own situation, and should be practiced on the healthy side at the same time. The improvement of muscle strength is the key factor of joint stability, must be practiced seriously. 4, in addition to the surgical limb braking protection, the rest of the body parts (such as the upper limb, waist and abdomen, the healthy side of the leg, etc.) should be practiced as much as possible to ensure physical fitness, improve the overall circulation and metabolism level, and promote the recovery of the surgical localization. 5. Early joint mobility (flexion and extension) exercises should be performed only once a day, aiming to improve the angle, avoiding repeated flexion and extension, and practicing many times. If there is no progress in flexion angle for a long time (>2 weeks), there is a possibility of joint adhesion, so it should be highly valued and insist on completing the exercises. 6.Ice packs should be applied for 15-20 minutes immediately after mobility exercises. If you usually feel the joint swelling, pain, fever is obvious, you can ice again, 2-3 times a day. 7, the swelling of the joints will be accompanied by the entire exercise process, swelling does not increase with the angle of the exercise and the increase in the amount of activity is a normal phenomenon, until the angle and the muscle strength of the basic return to normal swelling will gradually subside. Sudden increase in swelling should be adjusted to practice, reduce the amount of activity, serious cases should be timely follow-up. Early – inflammatory reaction period (0-1 week). Purpose: to reduce pain, swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy. In the early stage of functional exercises, the level of muscle strength is low, there is obvious inflammatory reaction in the tissues, and the reconstructed ligaments are still fragile. Therefore, static exercises (inactivity of the joints, holding a certain position until muscle fatigue) are the mainstay. Gradually increase the small load of endurance exercises, that is, the choice of light load (to complete 30 movements that is fatigue load), 30 times / group, rest 30 seconds between groups, 2-4 groups of continuous practice, until fatigue. No excessive walking! Walking should not be used as an exercise method! Otherwise, it is very easy to cause joint swelling and fluid accumulation, affecting functional recovery and tissue healing. (i) On the day of surgery: After the anesthesia subsides, start to move the toes and ankle joints; if the pain is not obvious, try to contract the quadriceps muscle. That is, the anterior thigh muscles are tensed and relaxed. (ii) The day after surgery: 24 hours after surgery, you can walk without your feet on the ground with the help of crutches (to the toilet only!) 1, Ankle Pump – Firm, slow, full range flexion and extension of the ankle joint, as much as possible while awake. (Important for promoting circulation, reducing swelling and preventing deep vein thrombosis) 2. Quadriceps (anterior thigh muscle group) isometric exercises – i.e., tensing and relaxing the thigh muscles. Do as much as possible without increasing pain. (greater than 500 times / day) 3, N rope muscle (thigh muscle group) isometric exercises – the affected leg force down the pillow, so that the thigh muscle tensing and relaxation. Requirements as above, greater than 500 times / daily. 4, the correct position placed DD affected leg elevated on the pillow, toes to the top, can not be skewed to one side, below the knee joint should be empty, not with a pillow to pad the leg into a slightly bent position. If the pain is intolerable, the leg should be placed in a comfortable position under the guidance of a physician. 5 thin femoral muscle, semitendinosus muscle reconstruction of the anterior cruciate ligament patients, start to try straight leg lift – straight leg lift after extending the knee to the heel of the foot off the bed at 15M, hold until exhaustion. 10 times / group, 2-3 groups / day. (Pain during the exercise is normal and should be tolerated). . (iii) 2 days after operation: Remove the drainage. 1. Continue the above exercises. 2. Ankle pump is changed to anti-gravity exercise (can be assisted by others or hold the thigh with hands). (Doing this after each time you get out of bed can effectively prevent swelling. (3) Start lateral leg raising exercise, 30 times/group, 2-4 groups/day, rest 30 seconds between groups. (4) Start backward leg raising exercise, prone (face down on the bed), the affected leg is straightened and lifted backward until the toe is 5 cm away from the bed for 1 time, 30 times/group, 2-4 groups/day, rest 30 seconds between groups. (iv) 3 days after surgery: according to the situation decided by the doctor to start joint mobility exercises. 1.Continue the above exercises. 2.Weight bearing and balance – Separate the feet under protection, move the center of gravity alternately from side to side within the range of slight pain, and strive to be able to achieve full weight bearing standing on one leg, 5 minutes/times, 2 times/day. -Separate the feet anteriorly and posteriorly, move the center of gravity, and strive to achieve full weight-bearing standing on one leg. (3) Begin flexion exercises (within the range of minimal pain.). Should be completed by the rehabilitation physician, or with the permission of the doctor under the guidance of the rehabilitation program to practice on their own, because the early practice is still dangerous, so do not practice blindly without authorization, otherwise it may cause adverse consequences.) 4, flexion exercises immediately after the ice about 20 minutes, such as the usual feeling of significant heat and swelling in the joints, you can then ice 2-3 times / day (such as cotton leg compression bandage has not been removed is not necessary to ice). 5 Extension exercises DD remove the splint, in the heel of the pillow, so that the affected leg completely off the bed, relax the muscles so that the knee joint natural extension. 30 minutes / times, 1-2 times / day. Intervals with flexion exercises should be as far away as possible. (v) 4-7 days 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 (on the healthy side). (3) Flexion exercises should be performed in the range of 0°-20°. (vi) 7-14 days after surgery: 1. Continue and strengthen the above exercises. 2. 2, Flexion exercises to 0°-30°, and may start active flexion and extension exercises. The method is shown in Appendix Flexion Exercise Method 7, ice after 5 times and gradually increase to 10-20 times. (vii) 2-4 weeks postoperatively: (Progress of flexion angle varies according to individual differences.) 1. Flexion angle is greater than 60°, and active flexion reaches 60°. 2, According to the degree of knee stabilization, adjust the 0° range of the brace. 3 For patients with ACL reconstruction of thin femoral muscle and semitendinosus muscle, “hooking leg” exercise in the standing position should be started 4-6 weeks after surgery. Initial stage: (4-6 weeks) Purpose: to strengthen the mobility and muscle strength exercises; to improve joint control and stability; to gradually improve the gait. (i) 4 weeks after surgery: 1. Passive flexion to 60-90°. 2. 2. Strengthen muscle strength exercises. (Straight leg raising can be done on the thigh side with weights as loads.) 3 If you can stand on one foot for 1 minute, you can walk with a single crutch, and you can walk off the crutch indoors. 4.Stretching can be the same as the healthy side (non-operated side of the leg). 5.Start to practice flexion on your own under guidance, see the notes for the method. 6. Gradually adjust the brace to 0°-, 30° range of flexion and extension, and increase the angle every 3-5 days, and adjust to 110° in 4 weeks after surgery. If the joint instability is obvious when walking and weight-bearing after adjustment, reduce the angle back to the pre-adjustment angle. (ii) 5 weeks after surgery: 1. Passive flexion to 90-100°. 2.Enhance active flexion and extension exercises and strengthen muscle strength exercises. 3.Begin to try to walk off the crutches. (iii) 6 weeks postoperatively: (sleep without support) 1, passive flexion to 100-110°. 2.Adjust the brace to 0°-45° range of flexion and extension. (3) Begin anterior-posterior and lateral straddle exercises, with the affected leg bearing weight on the anterior and straddle-out side. （Static squatting exercises. (back against the wall, feet shoulder width apart, toes and knee joints forward, not “inside and outside eights”, with the increase in strength gradually increase the angle of squatting (less than 60 °), 2 minutes / times, interval of 5 seconds, 5-10 consecutive / group. 2-3 groups / day. 5. Strive to achieve normal gait walking. Third, the middle stage: (7 weeks – 6 months) Purpose: strengthen the joint mobility to the same as the healthy side. Strengthen muscle strength and improve joint stability. Restore the ability of daily life activities. With the improvement of muscle strength level, absolute strength exercise is the main focus in the middle stage. Choose the medium load (the load of fatigue when completing 20 movements), 20 times/group, 2-4 consecutive groups of exercises, rest 60 seconds between groups, until fatigue. (i) 7 weeks after surgery: 1. Passive flexion up to 110-120°. 2, Start the affected side single leg 45° position semi-squatting flexion and knee extension exercises. The affected leg stands on one leg, the upper body is straight, slowly squatting to 45° of flexion, then slowly stirrups until fully extended. Requirements for slow, forceful, controlled (not swaying). 20-30 times / group, 30 seconds between groups, 2-4 times / day. 3, stationary bicycle exercises, no load to light load. 30 minutes / times, 2 times / day. (ii), 9-12 weeks postoperatively: 1, passive flexion angle gradually to the same as the healthy side. 2. After the “seated knee hold” is exactly the same as the healthy leg, begin to gradually protect the full squat. 3.Strengthen the muscle strength, but do not increase the load, but only increase the angle, frequency and time of the exercise). (iii) 12 weeks-6 months after surgery: 1, active flexion and extension of the knee angle is basically the same as that of the healthy side, and there is no obvious pain. 2, daily prone position flexion so that the heel touches the buttocks, continuous stretching for 10 minutes / times. 3.After holding the knee angle in sitting position was exactly the same as the healthy side, kneeling exercises were started. 4.Start pedaling exercises. 5, 6 months after the operation, if there are conditions can be carried out various functional tests, for the next stage of daily life and normal exercise to provide an objective basis. Post-operative period: (6 months-12 months) Purpose: to fully resume daily life activities. Strengthen muscle strength and joint stability. Gradually resume jogging and other sports. In the later stage, to improve the maximum strength, choose a large load (to complete 12 movements that is fatigue load), 8-12 times / group, 2-4 groups of continuous exercises, rest 90 seconds between groups, until fatigue. 1.Starting the knee loop exercise. 2. Start jumping up and down exercises. 3.Start lateral jumping exercises. 4.Begin swimming (breaststroke is prohibited in the early stage). Jumping rope and jogging. During this period, the reconstructed ligaments are not strong enough, so the exercises should be gradual and should not be forced or blindly advanced. And should strengthen the muscle strength to ensure the stability and safety of the knee joint in sports, if necessary, can wear knee pads to protect, but only advocate the use of strenuous exercise. Remarks: I. Flexion exercise methods: the following methods in accordance with their own flexion angle, any applicable method, once a day, and strive for a slight increase in the angle can be. If there is any special discomfort during or after the exercise, inform your doctor promptly. During the exercise, it is not allowed to straighten and rest, repeated flexion and extension, otherwise it will affect the effect, and it is very easy to cause swelling. 1.Patellar luxation (start after removing the stitches, no need for those who have flexible patellar activity): push the edge of the patella with your hand and push the patella slowly and forcefully in the up and down, left and right directions to the limit position. 20 times in each direction, 2-3 times/day. Can be performed before flexion exercises. 2. Sitting (or supine) position leg drop: (applicable to 0-95° range) Sit on the edge of the bed, hanging below the knee outside the bed. Relax the thigh muscles under protection, so that the calf naturally drooping, to the limit of protection for 10 minutes. If necessary, load can be added at the ankle joint. 3, supine hanging legs: (for more than 100 ° range) lying on the bed, thighs perpendicular to the bed (hands holding the legs to fix), relax the thigh muscles, so that the calves naturally droop, if necessary, can be added to the ankle joints at the load (the load should not be too large, otherwise the muscles can not be relaxed, that is, no effect). Requirements as above. 4, seated “top wall”: (applicable to 90-105 ° range) sitting on a chair, the affected side of the toe of the wall or fixed, slowly move the body forward to increase the angle of flexion of the knee, feel the pain to remain immobile, a few minutes after the pain disappeared or lowered, and then move forward, to the limit. See appendix 1-figure 10. 5, sitting position holding the knee: (applicable to the range of 100 ° or more) sitting on the bed, hands holding the ankle, so that the heel slowly close to the buttocks, starting in the third week after surgery. Measure the distance between the heel and the buttock before starting, and use 6-8 weeks to hold to the same angle as the healthy leg. This exercise should be gradual, do not blindly venture or fear of pain. 6, prone knee flexion: (for more than 110 ° range) prone position (face down on the bed), legs naturally stretched, hold the affected leg ankle joint, so that the knee flexion (can be a long towel or a wide band tied to the ankle, in order to facilitate the pull). Or by others to help, but absolutely prohibit violence push. 7.Active flexion and extension exercises: (performed after all passive flexion exercises, applicable to any angle range) sitting position, the foot does not leave the bed. Slowly and forcefully, maximize knee flexion, hold for 10 seconds and then slowly straighten. 10-20 times/group, 1-2 groups/day. Second, the practice of stretching and flexing: stretching exercises in the muscles and joints after the tugging feeling and slight pain is normal, not to contract the muscles against, should be completely relaxed, otherwise it will be ineffective. The weight of the load used in the exercise should not be too large, should make the affected knee dare to relax, continue to 30 minutes to the limit, there are obvious pulling sensation is appropriate. Do not take a break in the middle of the exercise, otherwise the effect will be affected. 1.Sitting knee extension: (within 3-4 weeks in early postoperative period) sitting position, foot cushion elevated, weight above the knee joint. Completely relax the muscles and keep it for 30 minutes. 30 minutes/time, 1-2 times/day. 2. Prone suspension: (after 4 weeks in the middle and late postoperative period, or if the straightening angle is obviously limited) prone, below the knee hanging out of the bed, and the weight at the ankle joint. Requirements are the same as above.