Note: Any post-operative rehabilitation program needs to be individualized on a case-by-case basis.
Stage 1: Within 4w of surgery
Rehabilitation goals
1. protection of the graft and immobilization of the affected limb with braces in addition to exercise; 2. control of inflammation and edema; 3. reduction of pain; 4. full extension of the knee joint; 5. flexion of the knee <90° in order to protect the fixation of the graft; 6. return to normal gait at a certain level.
Rehabilitation program
1.Pressure cold therapy, Tens, NMES, CPM
2.Functional training: active assisted calf flexion within 1w; active calf flexion after 1w, delayed strength exercises to 12w; heel sliding backward (<90 degrees); quadriceps isometric contraction; gastrocnemius/flounder muscle retraction; gentle s-string muscle retraction within 1w; SLR (various positions, with support); quadriceps multi-point isometric contraction
3.Weight-bearing: 0~1w, PWB of the affected limb with double crutches; 1~4 weeks, PWB progression to FWB
4, brace: 0~1w, brace locked at full extension during activity and sleep; 1~3w, brace locked at 90° when quadriceps muscle strength is insufficient; 3~4w, discard brace when patient has good control of quadriceps muscle and normal walking
Stage 2: 4w to 12w postoperatively
Criteria for assessing entry into stage II.
1. full knee extension/hyper-extension; 2. good quadriceps muscle strength with no extension lag in SLR; 3. flexion to 90 degrees; 4. basic elimination of edema and inflammation; 5. basic normal gait.
Rehabilitation goals
1. Maintain normal gait when climbing stairs ;2. Maintain full extension of the knee and try to increase the flexion angle;3. Protect the graft;4. Increase the strength of the hip, quadriceps and calf;5. Increase proprioception.
Rehabilitation plan
1, functional training: continue joint mobility and flexibility training; start quadriceps closed chain exercise (half squat, micro squat, etc.); progressive gluteus, s cord muscle, calf muscle training; continue s cord muscle, gastrocnemius, flounder muscle retraction; step training, treadmill (start weight loss running training at 10w to 12w); power bike training; proprioceptive training
2, brace: 4~8w after surgery, patients use brace in injury-prone situations (e.g. crowded, unstable roads)
3.After 4w, when the patient has reestablished a normal gait and is able to raise the leg straight and without extensor lag, the crutches or brace can be discarded in walking
Stage 3: 12w to 18/20w postoperatively
Criteria for assessing entry into stage 3.
1. no pain in the patellofemoral joint; 2. at least 120° of knee flexion; 3. sufficient strength and proprioception to begin running training; 4. resolution of edema/inflammation
Rehabilitation goals
1, total joint mobility; 2, improved muscle strength, endurance, proprioception of the lower extremity; 3, avoid overloading of the graft; 4, progressive s-rope resistance training; 5, protection of the patellofemoral joint; 6, normal running gait; 7, muscle strength of the affected lower extremity close to 70% of that of the healthy side
Rehabilitation plan
1.Continue mobility exercises, flexibility exercises
2.Open chain knee extension training
3.Isometric training
4.Start running exercises under full weight at 16w
5.Swimming
6.Isometric muscle strength test is recommended in 14-16w
7.Hip, quadriceps, s rope muscle, calf strength exercises
8.Endurance, proprioceptive training
Phase IV: Postoperative 4.5/5m～6/7m
Criteria for assessing entry into stage IV.
1, no severe edema or inflammation; 2, full range of painless joint mobility; 3, patellofemoral joint intact; 4, isometric muscle strength test of the affected limb up to 70% of the healthy limb; 5, sufficient strength and proprioception to begin agility training; 6, normal running gait
Rehabilitation goals
1.Bilateral symmetrical basic and sports agility exercises; 2.Single leg jump and triple jump up to 85% of the healthy side; 3.Quadriceps and N rope muscle strength, at least up to 85% of the healthy side
Rehabilitation plan
1.Continue flexibility and strength exercises
2.In order to achieve the patient’s athletic goals, start appropriate super-length training
3. Agility training: side walk; cross walk; figure 8 run; round trip run; single and double leg jump; acceleration/deceleration/jump; step exercise.