Patients should have a thorough understanding of ACL reconstruction surgery and postoperative rehabilitation. A rehabilitation plan should be developed based on a preoperative knee that is free of oozing and swelling, with full range of motion and good quadriceps and N-cord muscle strength.
Postoperative goals: Physical therapy should be performed on the same day as the surgery, with the ultimate goal of full knee mobility, no oozing swelling and muscle strength equal to that of the opposite side. This plan varies depending on the individual patient’s recovery progress. This plan also varies depending on the type of surgical fixation, additional procedures (medial and lateral collateral ligament repair and reconstruction, meniscal repair, etc.).
The first postoperative day
Objective To reduce pain and swelling. Walking: The patient is allowed to walk with partial weight bearing (using a brace with crutches). Sleeping in an extension splint (to be removed during CPM exercises) is mandatory. Exercises and activities.
① Patients should rest for the first few days after surgery with the knee elevated on the CPM machine and a cold therapy sleeve or ice pack applied externally on a continuous basis.
② Isotonic exercises should be started for the quadriceps.
Postoperative day 2 – 14
Objectives
① Obtain full extension or hyperextension as on the contralateral side
. ② Minimal swelling
③ Provide wound healing environment
④ Maintain control of quadriceps activity in the knee joint
⑤ Obtain 90 degrees of flexion.
Walking
① Patients can be partially weight-bearing with a brace and crutches
② Full weight-bearing with splint only after 7 days
③ Use a straightening splint at bedtime to fully straighten the knee joint
④ Walk as little as possible to reduce leg swelling
⑤ Remove splints during CPM, bathing, sitting, and resting
⑥ Replace the extension splint with a functional knee brace when the wound is healing.
Exercises and activities
① Passive extension + ice, heel pad elevation
② Passive flexion Sliding wall exercise
③ Towel pad heel and quadriceps electrostatic stimulation while the patient is sitting
④ Gastrocnemius tightening with towel around the foot to promote knee straightening ⑤ Isotonic: 60 degrees-90 degrees treatment band or opposite leg drive
⑥ Quadriceps exercises: standing against the wall, push the straightened knee back to straighten the knee into a rolled towel, further until the standing position straighten the knee to raise 30 degrees ⑦ The patient sits on the edge of the bed with the knee flexed and sagging, and the physiotherapist performs passive knee flexion ⑧ The physiotherapist moves the patella when patellar movement is limited ⑨ The hip joint is internally and externally rotated to the maximum ⑩ N cord muscle: active resistance exercise (not applicable after N muscle reconstruction?) Heel elevation? proprioceptive training: standing on the postoperative leg, further to golden chicken independence or using a rocker board
2-6 weeks postoperative
Objectives: ① increase knee flexion to 135 degrees ② reduce swelling ③ increase muscle strength; walking: allow full weight bearing walking (with extension splint or functional brace) at home without splint and brace Exercises and activities: ① supine position straight leg raise (quadriceps exercises) ② progress from double leg to single leg squat (45 degrees) ③ N rope muscle exercises: if you cannot fully flex, start prone position weight suspension ④ up and down step exercises from the initial 4-inch tread to 6-inch plate ⑤ ladder climbing: proceed slowly ⑥ stationary bicycle exercises to increase range of motion and muscle strength ⑦ swimming: start walking back and forth in the water after the incision heals Swimming with a life preserver between the knees or butterfly kicking ⑧ Further proprioception: take turns standing on the rocker board with both legs without transferring ⑨ Hip rotation with a therapeutic band (contraindicated after collateral ligament repair)
6-9 weeks postoperatively
Objectives: ① Further refine the range of motion ② Increase strength ③ Increase functional activities ④ Walking: can walk with full weight without splinting, continue to use functional brace during activities. Exercises and activities: ① swimming: increase in poolside fin kicking or swimming with a fin board, such as easy to further freestyle \\ backstroke ② walking slowly and comfortably in flat waist high water ③ outdoor flat bike without toe clamps or standing ④ power walking ⑤ patients with N cord muscle reconstruction can start N cord muscle resistance training
9-12 weeks after surgery
Objective: ① Increase functional activity ② Improve muscle strength and endurance Walking: full weight bearing; exercises and sports: ① further power walking/slow walking on the horizontal plane; ② sprinting; ③ cycling on all sections ④ horse stance: starting from 45 degrees to 90 degrees ⑤ double leg jumping ⑥ start neuromuscular isotonic exercises with counter shear device
More than 12 weeks after surgery
Objectives: ① Maintain full range of motion ② Enhance function, muscle strength and endurance Walking: complete weight bearing; exercises and movements: ① Muscle strength exercises for quadriceps and N cord muscles in metal frame (gym) ② Leg press and ascent squat still have to be done ③ Running straight ahead on flat ground at half speed ④ Running up stairs \\ down stairs ⑤ Introduce bicycle interval training ⑥ Balance board proprioceptive training and gym strength training ⑦ Jumping: progress to single leg jump, omnidirectional march, gradually increase jump height and distance. Then rabbit jumping
14 weeks after surgery
Exercises and sports: light sports activities (skiing in town, ice skating, golf, ice skating) are started only after no exudation, full mobility and 75% quadriceps \\N rope muscle strength, Lachman test (-), and doctor’s approval.
After six months postoperatively
Exercises and sports: ① If the reconstructed knee has 90% of the strength of the contralateral knee, various axial movements can be resumed ② One year postoperatively it is recommended or a functional brace, which can be withdrawn when the patient is confident in the affected knee, sometimes up to 18 months. ③ lateral and axial training can be started, start training around the 8, from large 8 slowly to small 8, fast (50m-30m-10m) 10 laps each time ④ sidewalk running, left foot in front of or behind the right foot to run 10m in the opposite direction, 5-10 times a day ⑤ directional running: to the same direction , running in the sidewalk , running backwards in the sidewalk 10 meters in a square, 10-20 times in each direction ⑥ half-speed steering run, run 20 meters turn after 90 degrees, and then run 20 meters turn in 90 degrees (10-20 times in each direction)