(A) Pre-operative preparation for ACL reconstruction process of knee joint
(1) Routine preoperative examinations: electrocardiogram, chest X-ray, blood and urine routine, blood biochemistry, infectious diseases, coagulation function.
(2) Special examinations: orthogonal and lateral x-ray of the knee joint; MRI film of the knee joint. X-rays of knee joint under internal stress, external stress, anterior drawer under stress, posterior drawer under stress, if necessary. Fu Jie, Department of Orthopedics, General Hospital of the Chinese People’s Liberation Army Rocket Force (3) Examination and treatment of common medical conditions: hypertension, diabetes mellitus, coronary heart disease, thrombotic disease; long-term medication registration.
(4) Pre-surgical knee function score for patients with chronic injuries.
(5) Patient education. Choice of graft material: patellar ligament, national cord tendon, allograft tendon, artificial ligament; choice of fixation material: absorbable transverse penetration nail and extrusion screw, metal interface screw, others.
(6) Judgment of the characteristics of the affected knee: conventional ACL reconstruction, multi-ligament reconstruction or repair (medial collateral ligament, lateral ligament complex, posterior cruciate ligament), revision, accompanied by meniscal injury requiring repair.
Postoperative management
(1) Negative pressure drainage should be left in place for about 3 days, and should be removed when the 24-hour drainage is less than 25 ml.
(2) Isometric contraction exercise of lower limb muscles for 0-1 day; CPM exercise after 1 day.
(3) Further rehabilitation is described in “Rehabilitation Guideline for Patients with Anterior Cruciate Ligament Reconstruction of the Knee Joint”.
(B) Rehabilitation guidance for patients with anterior cruciate ligament reconstruction of the knee joint
1. Pre-operative quadriceps (anterior thigh muscle) and Kokonoe muscle (posterior thigh muscle) strength exercises. (See later)
2.0-1 day after surgery (mainly rest and pain relief) elevate the affected limb, actively or passively move the ankle joint (10 times per hour in flexion and extension), and use special equipment to improve blood circulation in the lower limb.
Lower limb muscle isometric contraction exercise. (See after)
3. 2-21 days after surgery (restoration of joint range of motion mainly, followed by restoration of muscle strength) Support crutches to the ground according to physical tolerance, weight-bearing 50-75% of the affected limb, and gradually increase the range of motion.
Active and passive knee flexion exercises. (See later) Passive knee extension exercises. (See later) Strength exercises for the quadriceps (anterior thigh muscles) and the guojiao (posterior thigh muscles). (See later) Sleeping brace fixed in the extended position.
Push the patella exercise.
4, 3-6 weeks after surgery (to enhance muscle strength) to strengthen the quadriceps (anterior thigh muscles) and the national rope muscle (posterior thigh muscles) strength exercise. (See after) those who have conditions, can pedal exercise.
Intermittent crutches, walking limp is not obvious when you can abandon crutches.
Single-leg standing exercises.
Normal gait exercises.
Squatting exercises.
Up and down step exercises.
5.Continue to strengthen the quadriceps (anterior thigh muscles) and the guojiao (posterior thigh muscles) from 6 weeks to 6 months after surgery. (See later) Strengthen single-leg standing exercises, normal gait exercises, squat exercises and step-up and step-down exercises.
Gradually increase stride length and speed.
Resume adaptive exercises for normal work and life.
6.Recovery, non-confrontational sports activities from June to December after surgery.
Jogging, folding and running.
7.After 12 months postoperatively, start confrontational sports activities.
Quadriceps (anterior thigh muscles) strength exercise method.
Start with knee flexion in sitting position, or supine position with the knee joint padded up. Straighten the knee and keep it straight for 5 seconds, then relax and let the knee flex on its own, counting the 1st time in your mind; then straighten the knee again and keep it straight for 5 seconds, then relax and let the knee flex on its own, counting the 2nd time in your mind; …… until rest after 10 exercises. The total number of exercises per day varies according to individual circumstances, generally 250-300 times. When you feel that this exercise is easier, you can tie a 1 – 2 pounds of sandbags at the ankle.
National rope muscle (rear thigh muscle) strength exercise method.
At the beginning, prone position will be straight knee joint. The knee joint will be bent hard, and keep the hard bending state 5 seconds after relaxation, let the knee joint straight, the heart silent count for the first time; then again the knee joint hard bending, and keep the hard bending state 5 seconds after relaxation, let the knee joint straight, the heart silent count for the second time; …… until exercise 10 times after rest. The total number of exercises per day varies according to individual circumstances, generally 250-300 times. When you feel that this exercise is easier, you can fix a leather band at the foot of the bed, hook the ankle to the band and exercise the flexed knee.
Lower limb muscle isometric contraction exercise method.
The “lower limb muscle isometric contraction” is to make all the muscles of the lower limb tense, but the joints of the lower limb are not contracted by muscle extension and flexion activities. This exercise method is usually used in the early post-operative period and does not lead to increased pain and bleeding.
Passive knee extension exercise method.
In the supine position, the heel is elevated so that the lower extremity is relaxed and the knee is fully extended as far as possible.
In the prone position, the upper knee is elevated, the lower extremity is relaxed, and the knee is naturally lowered so that the knee is as fully extended as possible.
Active knee flexion exercise method.
Supine position, try to flex the knee joint, so that the heel is close to the hip.
Passive knee flexion exercises.
In supine position, elevate the thighs, relax the lower limbs, and allow the lower legs to drop naturally under gravity.
In the supine position, pull the ankle with a bandage and pull up with both hands towards the head end to flex the knee joint.
Sit on the edge of the bed with the thighs at the edge of the bed, so that the lower extremities are relaxed and the lower legs drop naturally under the effect of gravity.
Stand with your hands on the head of the bed and gradually squat down to flex the knee.