ACL Postoperative Period

8/8/2019 ACL Postoperative Period

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Postoperative period

Physical therapy will help your regain knee flexion (bending). However, being able to fully extend

(straighten) your knee soon after surgery is vital! If full extension is not achieved within the first eight

weeks, a second surgery may be necessary.

With this in mind, you must NEVER put anything under your knee when you are resting, sleeping, or

propping your leg up. The pillow must go under the heel.

IMPORTANT : NEVER put anything under your knee (see above)

Concerns:

1. Numbness around the incision site on the outside part of the knee is a result of a disruption of asuperficial nerve during the operative procedure. Most of this will resolve over time but a small area thesize of a quarter usually remains numb. This is unavoidable because of the proximity of the nerve to the

incision.2. A sudden rush or feeling of fullness with pain when going from a sitting to a standing position in the kneeis common after surgery.

Reduce Swelling

You will meet with a physiotherapist after surgery, if possible try and locate a Cryo Cruff to use for the

first week after surgery. This will help reduce swelling at a much quicker rate.

The use of one of these will help speed up the rate at which you can begin your rehabilitation program.

W eek 0 - 2: y The goals of the first two weeks of post-operational rehabilitation are to reduce swelling, restore full range

of motion in extension and flexion, ambulate without the use of crutches, and sit down and stand from aseated position.

y Proprioception is diminished following injury to the ACL, and it is therefore very important that this isregained following reconstructive surgery.After surgery, pain and swelling can inhibit the activity of your muscles. This can quickly result in muscle wasting which ultimately can lead to abnormal joint movementand can therefore create further problems.

y During the first week after surgery, rehabilitation is mostly passive. Regular icing and elevation are usedto reduce swelling. Your goal is full extension (or 10 degrees short of that) and 70 degrees of flexion bythe end of the first week.You should ice the knee as often as possible (especially after exercising) toreduce swelling and discomfort. Do not ice the knee more than 20 minutes at a time. Let the knee warmup before reapplication. Avoid getting your wound wet.



Some exercises that you may be able to perform near the end of Week 1 :

1. Gentle knee cap (patella) mobilizations : Sitting with you leg out straight and well supported, remove or undo your brace. Feel for the edges of your kneecap and using gentle pressure, slowly push your kneecap from side to side 5-10 times, and also glide it top to bottom 5-10 times.

2. Passive knee stretch / Knee hang: It is important to regain full extension of your knee as well as flexion.Place your heel on a block or rolled up towel so there is no support beneath it, let the knee ³hang´ for 3-5mins or as tolerated.

3. Ankle Pumps : With each foot separately or at the same time, point and flex the toes as if pumping thegas pedal of a car repeatedly, 25-50 times every five to 10 minutes.

4. Ankle Circles : With each ankle separately or at the same time, rotate the ankles in a large circle about 10times each direction, 25-50 times every five to 10 minutes.

Repeat 4-5 times a day or as necessary to get your knee straight

W eek 2 - 6:

SECTION 1: RANGE OF MOTION EXERCISES

Days per week: 7

Times per day: 2 - 31. Knee extensions : To perform these two exercises, place the heel of your injured leg on an object that is

a few inches thick (like a phone book). Gradually relax and let your leg come to full extension. This firstpart of the exercise helps you to maintain a normal range of motion.

2. Quad sets: After your knee has stretched out for a while, perform a set of ten quadriceps contractionswith your leg in the same position as in the Knee extensions. Without lifting your heel up in the air, tightenyour quadriceps muscle as hard as you can for ten seconds. Then relax for ten seconds before tighteningyour muscle again. Repeat this ten times. This exercise helps you to maintain quadriceps strength.

3. Heel Slides: For this next exercise, start with you injured leg stretched out. Then, while keeping your heelon the floor, gradually bend your knee and slide your heel towards your buttock. Bend your knee until itbecomes just slightly uncomfortable and you can feel a bit of pressure inside your knee. Hold it in thisposition for ten seconds. Then straighten your knee out again and relax for ten seconds. Repeat thisexercise ten times as well. This exercise will help you to maintain range of motion.

4. Straight leg raise: This exercise helps you maintain your quadriceps strength. Start with your leg flat onthe bed. Begin by tightening your quadriceps, as in the quad sets exercise. Then lift your leg off the beduntil your heel is approximately eighteen inches off of the bed and build up to holding for ten seconds.Lower your leg back down and repeat. Repeat this exercise five times.

SECTION 2: STATIONARY C YCLING

Days per week: 5

Times per day: 1

At this time, you can begin stationary cycling with both legs, using a spin or light resistance mode. Initiallyit is suggested that you set the seat height higher than normal so that it is easier to complete the cycling

motion. As the cycling becomes easier, you can adjust the seat height to your normal level. Begin very

slowly; as the knee feels stronger and more comfortable, increase the rpms with a spin or light resistance

mode. Start with approximately 10 - 15 minutes; your goal will be to achieve 30-45 minutes of cycling.

SECTION 3: WATER WORKOUT

Days per week: 3

Times per day: 1



Another excellent way of being able to perform some type of activity, and at the same time keep range of

motion and work the cardiovascular system, is to use the aquajogger exercise program. It is essential to

find a pool that is deep enough so that the feet do not touch the bottom. This exercise is totally non-

weight bearing and will allow for a very low impact type of movement sequence. We suggest between 20

and 30 minutes of actual jogging in the water per session.

SECTION 4: BALANCE TRAINING ( PROPRIOCEPTION )

Days per week: 5

Times per day: 1

After ACL surgery you need to retrain your leg by also completing balancing exercises. These involve

standing on one leg (your injured leg) and maintaining balance for 120 seconds. When you are

comfotable doing this, then you try and repeat but this time closing your eyes. This increases the

difficulty.

Two extra items that can be handy for proprioception are a wobble board and a mini trampoline. These

will greatly help in the balance training.

If you purchase a wobble board and/ or mini trampoline then exercise guides come with them. You can

also continue to do the exercise mentioned above. Always try and build up to 120seconds and beyond.

Step 1 is with eyes open, Step 2 with eyes closed and Step 3 is looking at feet and then looking to the

side.

W eek 6 - 11:

From six to twelve weeks, emphasis is placed on improved muscular control, proprioception and generalmuscular strengthening. Proprioceptive work progresses from static to dynamic techniques including

balance exercises on the wobble board and eventually jogging on a mini-tramp. The injured party should

have a full range of motion during this stage and gentle resistance work should be added. By the end of

this period the patient should be able to cycle normally, swim with a straight leg kick and be able to jog

freely on the mini-tramp.

Continue exercises from the previous section while adding the following :

Lunges:

y Stand with injured foot forward, other foot back about 3 feet apart. Bend the knees to lower the bodytowards the floor. Keep the front knee behind the toes and be sure to lower straight down rather thanforward.

y Keep the torso straight and abs in as you push through the front heel and back to starting position.

y Don't lock the knees at the top of the movement.

y Hold for five seconds and repeat five times.

Lunges should be done for both legs, make sure the knee never goes out in front of the toe.



Squats:

y Place your back against a wall or swiss ball resting on a wall. Position your feet slightly wider then hip-width apart with your toes slightly turned out.

y Slowly and under control bend your knees and lower yourself to a 90 degree angle without lifting your

heels off the floor and then after a brief pause at the bottom push your weight back up until you are backat the starting position

y Do 10 to 15 repetitions to finish one set before resting. You can repeat the set, but use your owndiscretion as to how much you can manage. Try to go for 5 sets.

Step ups:

Stand behind a 15-inch platform or step. Place the injured foot on the step, transfer the weight to the heel

and push into the heel to come onto the step. Concentrate on only using the injured leg, keeping the other

leg active only for balance.Slowly step back down and repeat all reps on the injured leg before switching

to the other leg. Perform 1-3 sets of 10-16 reps.

Leg Press: Single Leg Note: Only perform on the uninjured leg, do not use injured leg for this. You want to build up the strength

in the healthy leg.

Hamstring Exercise:

Placing your back against a wall or door, bend the knees to 90 degree angle . Have your feet 12 inches

out in front. Push back against wall/door and hold for ten second. Repeat five times.

Swimming:

Swimming can commence at this stage, but ensure that you only use the flutter kick, avoid breaststroke

until 4 months after surgery as this puts pressure on the ligament. Build up resistance and don't over do it.

Increasing Load: During this time period you should look to increase your work in the water and on the stationary bike.

Swelling around the knee should be reduced and you should be pain free. Increase time and resistance

on the bike and begin to swim in order to build back up cardiovascular fitness.

Continue Proprioception drills, e.g. wobble board exercises balancing on two legs, balancing on one leg,

ball tosses while balancing, done with the eyes closed for advanced drills. Repeat for mini- trampoline.

Months 3 - 6 From 3 Months to 6 Months continue with your exercises.You can often begin light jogging(figure of eight

rotations), cycling outdoors, and pool workouts. Side-to-side, pivoting sports -- such as basketball, soccer

and football -- must be avoided.

Toward the end of this phase, some people can begin shuttle runs, lateral shuttles and jumping rope. I

recommend running in a pool throughout this phase while building confidence in the knee.



Month 6 & BeyondIncrease cardiovascular work and build overall leg strength. If your knee is feeling strong you can begin to

do more dynamic moves like hopping along with vertical and multiple jumps, both legs; hops, one leg at a

time;

continue to concentrate on building hamstring strength to help prevent future injury. Single leg squats(have a bench behind you when practicing - so if you lose balance you can sit back on the bench) should

be emphasized to help build on the strength you have returned to your knee.

Conclusion

The road back from ACL surgery is a long one, after the initial gains you will find that progress is slow,

your knee feels different and you begin to wonder if it ever will be the same. If you follow a healthy rehab

program and monitor your knee you should beable to return to competitive sports.

Note: Don't worry too much about the 'crunching' sound you will hear/feel when you begin to run again,

this is built up scar tissue that will eventually break down. My main tip is to try and get confidence in the

knee as your muscle - mind connection will have been severly damaged after surgery. It takes a while to

build this back up - and remember warm up & warm down before exercise. I find a stationary bike is good

for loosing my knee before any exercise where i need to use my knee and gives me extra confidence it

wont break down.

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ACL Postoperative Period