Rehabilitation program after ACL reconstruction (focus)
Instructions
1.This plan should be implemented under the guidance of an orthopedic surgeon.
2.Since each patient’s condition is different, the specific rehabilitation exercises should be combined with the patient’s specific conditions to develop a suitable and personalized rehabilitation program.
3.After ACL reconstruction, wear a removable brace or hinged brace for 6-8 weeks. In addition to knee rehabilitation, active activities of adjacent joints can be started as early as possible.
4. Pain is inevitable during rehabilitation exercises. If the pain diminishes or disappears within half an hour after the exercise is stopped, there is no damage to the tissue and the rehabilitation can be continued.
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 in restoring joint stability and should be adhered to.
6, knee swelling will be accompanied by the entire exercise process, until the knee flexion and extension angle and muscle strength is basically back to normal, the knee swelling will gradually subside. If there is a sudden increase in knee swelling, you should adjust the exercises, reduce the amount of activity, and return to the hospital for a review if necessary.
7. Give ice packs for 15-20 minutes immediately after functional exercise. If the joint swelling, pain and fever are usually obvious, you can continue to apply ice packs 2~3 times a day.
Phase I: 1~7 days after surgery (postoperative edema period)
Brace requirement: Knee brace locked in 0 degree extension position. You can walk on the ground with the help of double crutches, without weight-bearing on the affected limb.
Functional exercise.
1. Ankle joint active flexion and extension exercise (ankle pump): the hard, slow, full range of plantar flexion and dorsiflexion activities of the ankle joint can promote blood circulation and eliminate swelling, which is important to prevent the emergence of deep vein thrombosis in the lower limbs. Once a day for 2 hours, 1~2 sets of 20 sets each time.
2, isometric training: quadriceps isometric contraction, N cord muscle isometric contraction exercises.
3.Activate the patella: push the patella up and down and left and right with your hands, 4 times a day, 1~2 sets each time, 4 directions per set, 15 sets each.
(1) Straight leg raise training: after extending the knee, keep the knee joint straight, raise it until the heel leaves the bed at 10~15 cm, hold it for 30~60 seconds/time.
(2) Exercise 3 sets per day, 20~30 times per set.
(3) Knee mobility exercise: the affected knee is required to be able to passively straighten to 0 degrees and flex the knee at an angle of less than 45 degrees. The following methods can be used, the principle of exercise is passive closed chain knee flexion exercise.
4, supine position closed chain knee flexion exercise: requires that the heel does not leave the bed during the process of knee flexion, moving on the bed surface, called “closed chain”.
5, can also use the foot along the wall to slide exercise instead; or can sit on a chair, the healthy side of the foot to assist the affected side of the knee flexion exercise.
6. Exercise 4 times a day for about 30 minutes each time.
Stage 2: 2~3 weeks after surgery (maximally protective period)
Progress to stage 2 criteria.
1, the strength of the quadriceps muscle is freely controlled and can do straight leg raise with relative ease
2.The knee joint can be fully and passively straightened
3.Passive flexion and extension of the knee joint up to 45 degrees
4.Good patellofemoral activity
5.Reduced knee swelling
Phase 2 exercise program.
1.Continue the above exercises
2.Add prone knee flexion exercises
3.CAM training
4.Terminal knee extension muscle strength exercises: knee extension strength exercises in the range of knee joint near extension (0~20 degrees), 4 times a day, 1~2 sets, 20 sets each time, 2 minutes rest between sets.
5.Resistance ankle plantar flexion training: against external resistance, toe force downward .
6, knee mobility training: passive knee flexion 0 ~ 100 degrees, active knee flexion 0 ~ 80 degrees
7.Foot slide training along the wall
8.Standing position: straight leg raise training, hook leg training
Stage 3: Controlled walking stage (4~6 weeks after surgery)
Criteria for progression to stage 3.
1.Active knee flexion and extension mobility 0~90 degrees
2. Further reduction of knee swelling
Postoperative week 4 exercise program.
1.Patellar luxation
2.Passive knee flexion and extension mobility: 0~105 degrees, active mobility: 0~90 degrees
3. Prone knee flexion and standing knee flexion exercises can be performed
4. Muscular strength training
(1) straight leg raise: can resist resistance, resistance from 0.5 pounds (or 250 grams) gradually increased to 5 pounds (2.5 kg)
(2) hip abduction, abduction, back extension resistance training: resistance from 0.5 pounds (250 grams) gradually increased to 5 pounds (2.5 kg)
(3) micro-squat training (0 ~ 30 degrees), each lasting 30 seconds, 20 repetitions per group, 3 groups per day
5.Biodex training (conducted in the hospital rehabilitation department)
(1) Active assisted knee mobility exercises
(2) Quadriceps multi-point isometric strength training
(3) Multi-point isometric strength training of the N cord muscle
6.Weight-bearing and balance training: Training under the guidance of therapists in the rehabilitation department.
(1) Partial weight-bearing training of the affected limb in the parallel bar (starting from 25%), weight shifting back and forth, left and right training
(2) Walking in the swimming pool for 20 minutes
(3) Power bicycle training 15 minutes
Post-operative 5~6 weeks exercise program.
1.Knee mobility training: passive knee mobility: 0~125 degrees, active mobility: 0~105 degrees
2.Resistance training of N cord muscle: resistance flexion of knee joint
3.Weight-bearing and balance training: partial weight-bearing training of the affected limb in the parallel bar (50%~100%), left-right, front-back transfer training of the center of gravity
4.Backward and forward, lateral stride training
5.Walking training with one crutch
6.Power bike training 15 minutes
Stage 4: 7-12 weeks after surgery (mid-protection stage)
Criteria for progression to stage 4.
1.Active knee flexion and extension mobility 0~125 degrees
2.Quadriceps strength loss ≤ 40% (Biodex measurement)
3, N cord muscle strength loss ≤ 20% (Biodex measurement results)
4.No significant change in KT-1000 measurement
Stage 4 exercise program.
At this stage, the patient can walk completely without crutches
1.Warm-up: power bike 15 minutes
2.Patellar luxation
3, knee flexion and extension mobility: passive knee flexion and extension mobility reached 0~140 degrees, active knee flexion and extension mobility reached 0~120 degrees
4.Strength training
(1) single-leg heel lift training: 20 / group
(2) power bicycle resistance training: 15 minutes
(3) squat training: 20 per group, 3 groups per day
(4) balance training: training on hard ground to stand on one foot, or use the balance board training
5.Up and down step training
6.Hip trainer resistance training: forward flexion, back extension, abduction, adduction
7.Biodex isometric endurance training quadriceps strength (in hospital rehabilitation department)
8.Gait training
Stage 5: Return to active activity stage (13-24 weeks postoperative)
Criteria for progression to stage 5.
1.Enhance strength, endurance
2.Begin to prepare for functional activities
3.No change in KT-1000 test
4.Biodex isometric test of quadriceps strength (16 weeks postoperative)
5.Quadriceps deficiency ≤35%, N cord deficiency ≤6%
Phase 5 exercise program.
1.Adaptive training: power bike
2, strength and coordination training: including isotonic muscle strength training (continue muscle strength training for open chain and closed chain) Progressive resistance training with resistance maintained at 70-75% of the maximum strength of the seated knee extension (determined by the rehabilitation department therapist)
3.Hip trainer training
4. Isometric training: Start 60° and 180° strength and endurance training with Biodex
5.Balance and stability training: Biodex balance training, Plyometrics training: jump up and down exercises, lateral straddle exercises; Trampline balance and proprioceptive training
6.Treadmill walking training
7.Flexibility training.
(1) Knee loop exercise
(2) lateral movement training
(3) lateral or backward running, vertical jumping, rope skipping, figure of eight running, emergency stop and turn training
(4) If the H/Q ratio reaches 80% in the isokinetic evaluation, professional sports activities can be trained.