Post-operative rehabilitation plan for ACL reconstruction
1.This plan should be implemented under the guidance of orthopedic surgeons.
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, a removable brace or hinged brace should be worn for 8~12 weeks. In addition to knee rehabilitation, active activities of adjacent joints can be started as early as possible.
4. Pain will exist during rehabilitation exercises and is inevitable. If the pain diminishes or disappears within half an hour after the exercise is stopped, there will be no damage to the tissue and the rehabilitation exercise 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 you usually feel swelling, pain and fever in the joint is obvious, you can continue to apply ice packs 2~3 times a day.
Phase I: 1~14 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. 2 hours once a day, 1~2 sets of 20 sets each time.
2, isometric training: quadriceps isometric contraction, N cord muscle isometric contraction exercises.
3.Activation of the patella: pushing the patella up and down and left and right with the hands, 4 times a day, 1~2 sets each time, 4 directions per group, 15 sets per group.
4.Straight leg raise training: after extending the knee, keep the knee straight, raise it to the point where the heel leaves the bed surface at 10~15 cm, hold it for 30~60 seconds/time. Exercise 3 sets per day, 20-30 times per set.
Knee mobility exercises: The affected knee is required to be able to passively straighten to 0 degrees and flex the knee at an angle of less than 60 degrees. The following methods can be used, the principle of exercise is passive closed chain knee flexion exercise.
1, 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”.
2, 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;.
3, daily exercise 2-4 times, each time about 0, 5-1 hours.
Stage 2: 3-4 weeks postoperative (maximally protective period)
Progression to stage 2 criteria.
1. the strength of the quadriceps muscle is freely controlled and able to achieve straight leg raise with relative ease.
2, ability to fully passively straighten the knee joint.
3, passive flexion and extension of the knee joint to achieve 0 to 90 degrees of activity.
4.Good patellofemoral activity.
5.reduction of knee swelling.
Phase 2 exercise program.
1.Continue the above exercises.
2.Adding 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 to 2 sets of 20 each, with 2 minutes rest between sets.
5. ankle plantarflexion training with resistance: toe press down hard against external resistance.
6, knee mobility training: passive knee flexion 0 ~ 90 degrees, active knee flexion 0 ~ 80 degrees.
7, foot sliding along the wall training.
8.Standing position: straight leg raise training, hook leg training.
Stage 3: Controlled walking stage (5~6 weeks after surgery)
Criteria for progression to stage 3.
1. active knee flexion and extension mobility of 0~90 degrees.
2. Further reduction of knee swelling.
Postoperative week 5 exercise program.
1, patellar luxation.
2, passive knee flexion and extension mobility: 0~105 degrees, active mobility: 0~90 degrees.
3. exercises for knee flexion in prone position and knee flexion in standing position are possible.
4. Muscular strength training.
Straight leg raise: resistance can be resisted, with resistance gradually increasing from 0, 5 pounds (or 250 grams) to 5 pounds (2, 5 kg).
Hip inversion, abduction and back extension resistance training: resistance gradually increases from 0, 5 pounds (250 grams) to 5 pounds (2, 5 kilograms).
Micro-squat training (0~30 degrees), each lasting 30 seconds, 20 repetitions per group, 3 groups per day.
5.Biodex training (performed in hospital rehabilitation department)
Active-assisted knee mobility exercises.
Strength training for multiple points of isometric quadriceps.
Strength training for multiple points of isometric N cord muscle.
6.Weight-bearing and balance training: Training under the guidance of therapists in the rehabilitation department.
Partial weight-bearing training of the affected limb in the parallel bar (starting from 25%), weight shifting training forwards and backwards, left and right.
Walking in the swimming pool for 20 minutes.
Power bike training for 15 minutes.
6 weeks post-operative exercise program.
1.Knee mobility training: passive knee mobility: 0~125 degrees, active mobility: 0~105 degrees.
2. N cord muscle resistance training: resistance flexion of the knee joint.
3.Weight-bearing and balance training: partial weight-bearing training of the affected limb within the parallel bar (50%~100%), left-right, front-back transfer training of the center of gravity.
4, anterior-posterior and lateral stride training.
5, single crutch walking training.
6.Power bicycle training for 15 minutes.
Stage 4: 7-12 weeks postoperative (intermediate protection stage)
Criteria for progression to stage 4.
1. active knee flexion and extension mobility of 0 to 125 degrees.
2. quadriceps strength loss ≤ 40% (as measured by Biodex).
3, N cord muscle strength loss ≤ 20% (Biodex measurement result).
4.No significant change in KT-1000 measurement.
Stage 4 exercise program.
At this stage the patient was able to walk completely off the crutches
1. warm-up: power bicycle for 15 minutes.
2, patellar luxation.
3, knee flexion and extension mobility: passive knee flexion and extension mobility of 0 to 140 degrees, active knee flexion and extension mobility of 0 to 120 degrees.
4. Strength training.
Single-leg heel lift training: 20 units/group.
Power bicycle resistance training: 15 minutes.
Squat training: 20 per group, 3 groups per day.
Balance training: training on hard ground to stand on one foot, or using a balance board.
step-up and step-down training.
hip trainer resistance training: forward flexion, back extension, abduction and adduction.
Biodex isometric endurance training for quadriceps strength (performed in hospital rehabilitation units).
5. proprioceptive training (knee joint stability training).
6. center of gravity transfer training.
7. backward walking.
8. Gait training.
Stage 5: Return to active activity stage (13-24 weeks postoperative)
Criteria for progression to stage 5.
1. increase in strength, endurance.
2. Initiation of preparation for functional activities.
3. no change in KT-1000 test.
4. Biodex isometric test of quadriceps strength (16 weeks postoperative).
5.Quadriceps deficiency ≤ 35% and N cord deficiency ≤ 6%.
Phase 5 exercise program.
1, adaptation training: power bicycle.
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 seated knee extension strength maximum (to be determined by the rehabilitation therapist after measurement).
3. hip trainer training.
4. isometric training: 60° and 180° strength starting with Biodex, endurance training.
5.Balance and stability training: Biodex balance training, Plyometrics training: jump-up and jump-down exercises, lateral straddle exercises; Trampline balance and proprioceptive training.
6, Treadmill walking training.
7. Flexibility training.
Knee loop exercises.
Lateral movement training.
Lateral or backward running, vertical jumping, rope skipping, figure 8 running, emergency stop-and-go training.
If the H/Q ratio reaches 80% in the isokinetic assessment, professional sports activities can be trained.