Rehabilitation program for anterior cruciate ligament of the knee surgery Correct postoperative position placement: the affected leg is elevated on a pillow, the toe of the foot is to the right side, not crooked to one side, the knee should be empty below the knee, and the leg should not be padded with pillows into a slightly curved position. Purpose: to reduce pain, swelling; early muscle strength exercises; early mobility exercises to avoid adhesion and muscle atrophy. Functional exercises in the early stage and the initial period, due to the low level of muscle strength, tissue there is a more obvious inflammatory reaction, and reconstruction of the ligament is still relatively fragile, so the static exercises (joint inactivity, maintain a certain position until muscle fatigue) is the main. Gradually increase the small load of endurance exercises, choose a light load (to complete 30 movements that fatigue load), 30 times / group, rest 30 seconds between groups, 2-4 groups of continuous practice, until fatigue. Do not walk too much, should not use walking as an exercise method. Otherwise, it is very easy to cause joint swelling and fluid accumulation, affecting tissue healing and functional recovery. (1) On the day of surgery: After the anesthesia begins to subside, start to move the toe and ankle joints, if the pain is not obvious, try to contract the quadriceps muscle. If the pain is not obvious, you can try to contract the quadriceps muscle, i.e., tensing and relaxing the muscles of the anterior thigh. (2) 1 day after surgery: 24 hours after surgery, you can walk without walking on the ground with the help of crutches (only to go to the bathroom). ①Ankle pump exercise: active ankle flexion and extension exercises, slowly, forcefully, maximally, repeatedly, and as much as possible when awake. This exercise is important to promote circulation, reduce swelling and prevent deep vein thrombosis. Quadriceps isometric exercises: do as much as possible without increasing pain, more than 500-1000 times/day. It can avoid muscle atrophy as much as possible, and at the same time promote blood circulation in the lower limbs. ③ Slap rope muscle isometric exercises: do as much as possible without increasing pain, more than 500-1000 times / day. It can avoid muscle atrophy as much as possible, and at the same time promote blood circulation in the lower limbs. ④You can start to try the straight leg raising exercise: hold it until exhaustion for one time, 5-10 times/group, 2-3 groups/day (pain during the exercise is normal and should be tolerated) (3) 2 days after surgery: ①Continue to strengthen the above exercises. ② After walking on the ground, you can perform “anti-gravity ankle pump exercises” to promote blood return to the distal limb. ③Start lateral leg raising exercises: 30 times/group, 30 seconds rest between groups, 2-4 groups of continuous exercises, 1-2 times/day ④ Posterior leg raising exercises: after strengthening the strength, you can add sandbags to the ankle joint as a load to strengthen the exercises. 30 times/group, 30 seconds rest between groups, 2-4 groups of continuous exercises, 1-2 times/day ⑤ Continue and strengthen the above exercises. 30 times/group, 30 seconds rest between groups, 2-4 groups of continuous exercises, 1-2 times/day. (4) 3-7 days after surgery: ① Continue and strengthen the above exercises. ② weight-bearing and balance exercises: under the protection of the muscles of the legs tensed to control the movement and balance of the body, gradually increase the weight of the affected limb and the degree of force, and gradually achieve the affected side of the single leg fully weight-bearing standing. 5 minutes / time, 2 times / group, 2-3 groups / day. ③Ice immediately after the exercise for about 20 minutes, if you usually have the feeling of obvious warmth and swelling in the joints, you can ice again 2-3 times/day. 2. Early stage (2-4 weeks after surgery) Purpose: to strengthen the mobility and muscle strength exercises; to improve joint control and stability; 2 weeks after surgery: to strengthen the muscle strength exercises. Other exercises are the same as before. Postoperative 3 weeks: ① passive flexion exercises: passive flexion angle to 90 degrees. CPM machine 0-30 degrees to start, increasing by 10 degrees every day ② strengthen the active flexion and extension exercises, strengthen the muscle strength exercises. ③Start to try to hold the crutches and walk with the affected limb partially weight-bearing. Postoperative 4 weeks: Sleeping and resting need to be fixed in the straight position with support. Passive flexion exercises: passive flexion angle to 100 degrees. ②Adjust the brace to 0-90 degrees range of flexion and extension. ③Start front and back, lateral stride exercises: require slow, controlled movements, the upper body does not sway. After the strength is enhanced, you can lift heavy objects with both hands as load or add sandbags at the ankle joint as load. 20 times/group, rest 30 seconds between groups, 2-4 consecutive groups, 2-3 times/day. 3. Intermediate stage (5 weeks-3 months after surgery) Objective: strengthen the joint mobility to the same as the healthy side; strengthen the muscle strength; improve the stability of the joint; resume daily life. 5-6 weeks after surgery: ① Passive flexion angle to 110 degrees. ②Start static squatting exercises: squat to a pain-free angle, adjust the distance of the foot from the wall, so that the knee has been perpendicular to the toe squatting angle of less than 90 degrees. 2 minutes / times, interval of 5 seconds, 5-10 times / group, 2 groups / day. (iii) Patients with conditions and insignificant joint swelling and pain can begin stationary bicycle exercises to improve joint mobility. No load to light load. 20-30 minutes/repeat, 2 times/day. ④ Start gait walking exercises. 7 weeks after surgery: ① Passive flexion angle to 120 degrees. ② Single-knee squatting exercises: squatting in the range of 0-45 degrees, requiring slow, controlled movements and no swaying of the upper body. If necessary, you can lift heavy objects with both hands to increase the difficulty of the exercise. 20 times/group, 30 seconds interval, 2-4 consecutive groups, 1-2 times/day. Postoperative 8-10 weeks: ①Passive flexion angle gradually to the same as the healthy side. At the same time, increase prone stretching to strengthen the knee mobility. ② Strengthening of various muscle strength exercises: seated resistance knee extension: use sandbags and other loading exercises, 30 times/group, 30 seconds rest between groups, 4-6 consecutive groups, 2-3 times/day. As the level of muscular strength increases, the exercises of absolute strength will be the main focus. Choose moderate load, 20 repetitions/set, 2-4 consecutive sets of exercises with 60 seconds of rest between sets, to fatigue predominantly. Postoperative 10 weeks-3 months: After review, the brace can be removed according to the situation. ① Active knee flexion and extension angle is basically the same as that of the healthy side, and there is no obvious pain. At the same time, increase prone stretching to strengthen the knee mobility. ② Daily prone position flexion so that the heel to hip distance is the same as that of the healthy leg, continuous traction for 10 minutes/time. ③ step forward downward exercise: after the strength is strengthened, you can use both hands to lift heavy objects as a load or add sandbags at the ankle joint as a load. Requirements for slow, controlled movements, the upper body does not sway. 20 times / group, rest 30 seconds between groups, 2-4 consecutive groups, 2-3 times / day. ④ Full squat under protection: Distribute the weight equally between legs, make the buttocks touch the heel as much as possible. 3-5 minutes/repetition, 1-2 times/day. 4. Post-operative period (4-6 months after surgery) Objective: to fully resume daily life activities; to strengthen muscle strength and joint stability; to gradually resume sports. (1) Gradually restore the functions of the knee joint. (2) Gradually resume daily life activities. (3) If conditions permit and the joints are in good condition, you can start swimming, jumping rope and jogging. Note: The reconstructed ligaments are not strong enough during this period, so the exercises should be gradual and should not be forced or blindly advanced. And should strengthen the muscle strength to ensure the stability and safety of the knee joint in sports, if necessary, can wear knee pads to protect, but only advocate the use of strenuous exercise. 5. Recovery period (7-12 months) Purpose: to fully recover from sports or strenuous exercise, strengthen the muscle strength and the stability of the joints in running and jumping, and gradually resume strenuous activities or special exercises.