AclN post-operative rehabilitation program for rope muscle reconstruction
This rehabilitation program is designed for patients undergoing reconstruction of the acl, but the specific training program will depend on the patient’s specific post-operative examination, the speed of recovery, or the presence of other injuries to the combined knee joint, and the final determination of the specific program is up to the surgeon and the rehabilitation physician.
Pre-operative rehabilitation instruction.
Introduce yourself and educate the patient on the need for preoperative and postoperative rehabilitation
Instruct the patient on position transfer, prone to sitting, sitting to standing
Instruct patient on post-operative knee training exercises and briefly describe training progress during hospitalization
Instruct the patient to use a walker or crutches and learn to control the center of gravity
Principles of postoperative rehabilitation.
The reconstructed ligament is reshaped at 8 weeks and gradually increases in strength from 8 to 12 weeks.
In combination with meniscus suture surgery, the ROM training schedule and weight-bearing time will be determined by the meniscus repair
Patients with combined MCL injury, avoiding valgus stress
The surgeon will determine the duration of brace and crutch use
Post-surgical rehabilitation is recommended to last 4-6 months
Early stretching and strength training for the N cord should be done with caution to avoid compromising the recovery of the N cord after tendon removal
N cord PRE after 12 weeks
Approximate recovery process in daily life
Sleeping with knee extension brace for one week after surgery, after one week you can sleep without knee extension brace if there is no lag in knee extension
You can drive after 4 weeks
Walking with crutches and brace for 4 weeks
Use of brace
0-1 week, knee extension brace immobilization during position transfer and sleep
2-3 weeks, if quadriceps muscle strength is well recovered, the brace can be adjusted within 90° for protection
3-4 weeks, if quadriceps muscle strength is well recovered and gait is normalized, the brace can be removed
5-8 weeks, use the brace only in crowds and on uneven surfaces
Weight-bearing
0-1 week, brace protection, partial weight bearing with crutches
1-4 weeks, gradual transition from partial weight bearing to full weight bearing to normal gait
If quadriceps muscle strength recovers well and gait returns to normal, the brace can be removed
Phase I: Immediate postoperative period to 1 week postoperative
Objective.
Protect the reconstructed ligament
Control swelling and inflammation
Maintain full extension of the postoperative knee and avoid hyperextension
Control knee flexion to no more than 60°
Training method
Continuous cold compression for 45 minutes in the morning and afternoon two days after surgery, followed by 15 minutes of cold compression after each training session
Postural elevation of the affected limb
Tri-sets, Ankle pump, 20 times per hour
Under-heel elevation, active knee compression for 5 minutes per hour to keep the knee fully extended
Sit up and bend forward and gently stretch the N cord muscle
Push the patella in all directions
Do SLR centrifugal muscle exercises in all directions, you can first do lateral SLR in the healthy side, followed by hip flexion in the healthy side, if you can do it easily, you can try SLR in the supine position (knee extension brace fixed)
Encourage the patient to sit up in bed and avoid prolonged lying down
Exercise the extensor muscles of the healthy leg and upper extremity to prepare for the lower walker training
ROM training started on the third postoperative day with passive knee flexion of 60° with CPM/WALL SLIDE
Early knee extension brace fixed walker or double crutch TTWB
Phase 2: 2-4 weeks postoperatively
Requirements for entering this phase
Completion of isometric contraction of the quadriceps and SLR
Flexion of the knee to 60°
Full extension of the knee
Stand on the ground with the protection of a knee extension brace
Rehabilitation goals.
Control of swelling and pain
Consolidation of full knee extension
Control of 90° of knee flexion
Good control of the quadriceps
Good gait with knee extension brace protection and walker support
Training methods.
Under-heel elevation to maintain full knee extension
Isometric contraction of the quadriceps (can be combined with NMES)
Centrifugal muscle training with SLR in all directions (knee brace protection until muscle strength returns to no lag in knee extension)
CPM/WALL SLIDE passive knee flexion 90°
Supine position with heel against the bed and active knee flexion and extension controlled to 90°
Bedside seated position with elastic band to immobilize the proximal tibia and limit anterior tibial translation, with isometric contraction of the quadriceps at 30°, 60° and 90°
Gait training with a walker under the protection of a knee extension brace
Increase TTWB to WBAT
Teach patient to walk up and down stairs
Phase 3: Postoperative week 5-6
Requirements for entering this phase
Decrease in swelling
Good quadriceps control with no lag in knee extension
Flexion of the knee to 90°
Full extension of the knee
Rehabilitation goals
Progressive return to normal ROM (patients with combined meniscal sutures, limit knee flexion to 90° for 6 weeks)
Return to normal gait
Protection of reconstructed ligaments
Improve proprioception
Training methods
Stretching the N cord muscle
Protected, seated multi-point isometric training
Micro squats
Heel lift exercises
Standing ball throwing and catching training
Proprioceptive training (soft mat standing, balance board control of center of gravity, etc.)
Closed chain TKE
Gait training
Phase 4: Post-operative week 7-12
Requirements for entering this phase
Normal gait
Normal ROM
Good lower extremity muscle strength, able to perform basic functional activities of life
Rehabilitation goals
Normal gait, normal walking up and down stairs
Protection of reconstructed ligaments
Good lower extremity muscle strength
Improved proprioception
Training methods
Knee ROM training
Leg Press 30-90°
Single Leg Squat
Step training
Single leg ball throwing training
One-legged cushion and balance board training (eyes open or closed)
Phase 5: 13 weeks to 6 months after surgery
Requirements for entering this phase
No significant pain in the knee joint
Knee flexion of 120°
Normal life activities
Rehabilitation goals
Increase lower extremity muscle strength (quadriceps, N cord) and improve H/Q values
Enhance explosive power and proprioception in preparation for return to sports
Normal running
Isometric muscle strength test of the affected limb to 70% of the healthy side
Training methods
N-cord resistance muscle training
Open chain muscle training, mainly centrifugal muscle training, angle control 30-90 °
Full weight-bearing running around week 16
Jumping training
Specialized training