ACL Recovery Protocol

8/9/2019 ACL Recovery Protocol

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ACL Reconstruction Rehabilitation Protocol

Peter J. Millett, MD, MSc

The Steadman Clinic

Vail, CO

www.drmillett.comACL Reconstruction Rehabilitation Protocol

!

Table o" Contents

Preo#erati$e RehabilitationPhase................................................................................%

&nderstandin' Sur'er( ..............................................................................................)

Posto#erati$e Da(s * )............................................................................................+

Posto#erati$e Da(s + * ........................................................................................*!

Posto#erati$e -ee !.............................................................................................. *%

Posto#erati$e -ee s % /........................................................................................*0

Posto#erati$e -ee s / 0........................................................................................

*)

Posto#erati$e -ee s 0 1 *! .....................................................................................*)

Posto#erati$e -ee s *! 1 ! ....................................................................................*+

!/ -ee s Posto#erati$e 20 months3 ..........................................................................*+

Medication Re'imen ................................................................................................*+

List o" 4i'ures

4i'ure *. 5eel #ro# usin' a rolled towel. .................................................................../

4i'ure !. Prone 5an'. 6ote the nee is o7 the ed'e o" thetable. ................................./


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4i'ure %. -all Slide8 Allow the nee to 'entl( slidedown.............................................9

4i'ure /. 5eel slide 1 le' is #ulled toward thebuttoc s ...............................................9

4i'ure 9. 5eel slides in later sta'es o"rehabilitation ...................................................9

4i'ure 0. Stationar( :ic(cle hel#s to increasestren'th................................................0

4i'ure ). &se the non in;ured le' to strai'hten the nee ...........................................*

4i'ure +. Passi$e 4le


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T5B 5 5BST 6C DB6CB O4 E6BB ST 446BSS OCC&RS 4 ACL S&R BRF SPBR4ORMBD

-5B6 T5B E6BB S S-OLLB6, PA 64&L, A6D 5AS A L M TBD RA6 B O4 MOT O6.

The ris o" de$elo#in' a sti7 nee a"ter sur'er( can be si'ni@cantl( reduced i" thesur'er( is

dela(ed until the acute in ammator( #hase has #assed, the swellin' has subsided,a normal

or near normal ran'e o" motion 2es#eciall( e


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a$oid >uadrice#s atro#h(. Fou are encoura'ed to bear as much wei'ht on the le' asis

com"ortable.

Control Pain and Swellin'

cin' alon' with nonsteroidal anti in ammator( medications such as Ad$il, 6u#rin,Motrin,

bu#ro"en, Ale$e 2! tablets twice a da(3 are used to hel# control #ain and swellin'. The

nonsteroidal anti in ammator( medications are continued "or ) * da(s "ollowin'the

acute in;ur(.ACL Reconstruction Rehabilitation Protocol

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Restore normal ran'e o" motion

Fou should attem#t to achie$e "ull ran'e o" motion as >uic l( as #ossible.Iuadrice#s

isometrics e


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%3 Prone han' e


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*3 Stationar( :ic(cle. &se a stationar( bic(cle two times a da( "or * ! minutesto hel#

increase muscular stren'th, endurance, and maintain ran'e o" motion. See 4i'ure 0

4i'ure 0. Stationar( :ic(cle hel#s to increase stren'th

!3 Swimmin' is also another e


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Prior to be'innin' the o#eration and at the conclusion o" the o#eration, a solutioncontainin'

a lon' actin' local anesthetic Marcaine will be in;ected into (our nee. This solutionwill

bloc the #ain ner$e @bers and local #ain rece#tors in (our nee. Recent studiesha$e

shown that this is a sa"e and e7ecti$e wa( to control #ain a"ter nee sur'er(. nman(

cases the in;ection will last *! or more hours a"ter sur'er( and si'ni@cantl( reducethe

amount o" #ain medication that (ou will ha$e to ta e.

A"ter Sur'er(Prior to lea$in' the o#eratin' room a nee immobili?er and an ice machine will bea##lied to

(our nee.

The ameRead( ice machine will #ro$ide cold and com#ression, reducin' #ain

and swellin'. This unit should be used continuousl( "or the @rst % / da(s a"ter

(our sur'er(. A"ter this time #eriod the ame Read( can be used as needed "or

com"ort. The ame Read( should be used "or a##ro


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"or trans#ortation.ACL Reconstruction Rehabilitation Protocol

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Posto#erati$e Da(s * )

4ollow the 'uidelines within this section "or the @rst se$en da(s a"ter (our sur'er(

T S BNTRBMBLF MPORTA6T T5AT FO& -ORE O6 BNTB6S O6 MMBD ATBLF.

oals8 G Control #ain and swellin'

G Care "or the nee and dressin'

G Barl( ran'e o" motion euadrice#s musclesG ait trainin'


*3 Control Swellin'. 4ollowin' dischar'e "rom the hos#ital (ou should 'o homeele$ate (our

le' and ee# the nee iced usin' the ameRead( coolin' unit. Fou ma( 'et u# touse

the bathroom and eat, but otherwise (ou should rest with (our le' ele$ated.!3 Do not sit "or lon' #eriods o" time with (our "oot in a de#endent #osition 2lowerthan the

rest o" (our bod(3, as this will cause increased swellin' in (our nee and le'. -hen

sittin' "or an( si'ni@cant #eriod o" time, ele$ate (our le' and "oot.

%3 Control Pain. Fou will be sent home with a #rescri#tion "or a stron' narcoticmedication.

Fou should ta e this "or se$ere #ain, as directed on the #rescri#tion bottle label./3 As (our #ain and swellin' decrease (ou can start to mo$e around more ands#end more

time u# on (our crutches.Peter J. Millett, MD, MSc

S#orts Medicine and Ortho#aedic Sur'er(


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=

Carin' "or (our nee

*3 The @rst ni'ht and da( a"ter the sur'er( (ou can e


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oHce at 2=) 3 /)= 9+)=.

)3 Fou ma( remo$e the nee brace while doin' e


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im#ortant to achie$e at least = de'rees o" #assi$e euadrice#s muscle and decreases

swellin' b( s>uee?in' uid out o" the nee ;oint.

!3 :e'in strai'ht le' raises 2SLR3 with the nee immobili?er on + sets o" *re#etitions %

times a da(. Start b( doin' these euadrice#s contraction with the

le' in "ull euadrice#s contraction loc s the nee and #re$ents

e


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sa''in' 2>uad la'3. Once (ou ha$e 'ained stren'th, strai'ht le' e


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oals8 Ph(sical thera#(

Maintain "ull euadrice#s isometrics, SLR, acti$e euirements decrease, and (ou can sa"el( wal with (our


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crutches. T(#icall( this is between 9 * da(s a"ter sur'er(.

!3 Patients who ha$e ;obs where li'ht dut( is not #ermittedU #olicemen, @remen,

construction wor ers, laborers, will be out o" wor "or a minimum o" 0 *! wee s.

Posto#erati$e -ee %

&se the 'uidelines in this section durin' the second wee a"ter (our sur'er(

oals8 G Maintain "ull euat usin' Table "or stabili?ationACL Reconstruction RehabilitationProtocol

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!3 Start Toe Raises.


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&sin' a table "or stabili?ation, 'entl( raise the heel o7 the oor and balance on

the ball o" the "eet.

5old "or 0 seconds and ease slowl( bac down.

Do % sets o" * re#etitions each da(.

4i'ure **. Toe Raise

%3 Continue to use the nee brace "or wal in' e$en i" (ou ha$e 'ood muscle controlo" the

le'. This will #rotect (our 'ra"t.

/3 -ean "rom crutches when (ou can #ut "ull wei'ht on the le' and wal with anormal

heal toe 'ait and no lim#.

93 Fou can continue usin' a stationar( bi e. C(clin' is an e


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*3 At this #oint (ou should be'in reducin' the amount o" narcotic #ain medication(ou ta e.

Fou will be instructed on how to do this durin' (our "ollow u# a##ointment.

!3 Once (ou ha$e @nished the anti in ammator( that was 'i$en to (ou, (ou canta e an

o$er the counter anti in ammator( medication, #ro$ided (ou ha$e no histor( o"

stomach ulcer. The chea#est and sim#lest medication to ta e is Ad$il, Motrin, 6u#rinor

Ale$e, ! tablets twice a da(. This medication will hel# to #re$ent scar tissue "rom

"ormin' in the nee, and also hel# to #re$ent blood clots "rom "ormin' in (our le's.

-hen can (ou dri$e a car

RBMBM:BR, T S LLB AL TO TAEB PRBSCR PT O6 PA 6 MBD CAT O6S A6D

OPBRATB A MOTOR VB5 CLB

4irst, (ou must not be ta in' an( #rescri#tion #ain medications.

Patients who ha$e had sur'er( on the le"t nee, and who ha$e an automatic

transmission ma( dri$e when the( can com"ortabl( 'et the le' in and out o" the

car.

Durin' dri$in' the nee brace can be unloc ed.

Patients who ha$e had sur'er( on the le"t nee and ha$e standard transmissions,

should not dri$e until the( ha$e 'ood muscular control o" the le'. This usuall(

ta es % / wee s.

Patients who had sur'er( on the ri'ht nee should not dri$e until the( ha$e 'ood

muscular control o" the le'. This usuall( ta es / 0 wee s. ACL ReconstructionRehabilitation Protocol

*0

Posto#erati$e -ee s % /

oals8 G 4ull ran'e o" motion


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G Stren'th throu'h euadrice#s isometrics and strai'ht le' raises 2see 4i'ure =3.

%3 Continue #artial s>uats and toe raises 2see 4i'ure * and 4i'ure **3.

/3 " (ou belon' to a health club or '(m (ou ma( start to wor on the "ollowin'machines8

Stationar( bi e. Seat #osition re'ular hei'ht to hi'h to a$oid too much bendin'

or strai'htenin' o" the nee. ncrease resistance as tolerated. Tr( to wor u# to

*9 ! minutes a da(.

Blli#tical cross trainer *9 ! minutes a da(.

nclined le' #ress machine "or the >uadrice#s muscles. ) de'ree ran'e. See

4i'ure *!

4i'ure *!. Le' #ress usin' = de'ree ran'e

Seated le' curls machine "or the hamstrin' muscles. 6ote this e


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*3 Four euats, toe raises, stationar( bi e,

elli#tical machine, le' #resses, and le' curls.

%3 Tilt board or balance board e


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93 Start treadmill 2 at onl(3.

03 Fou ma( be'in outdoor bi e ridin' on at roads.

6O MO&6TA 6 : E 6 OR 5 LL CL M: 6 ACL Reconstruction Rehabilitation Protocol

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Posto#erati$e -ee s *! 1 !

oals8 G Continued stren'th

G ntroduce ;o''in' and li'ht runnin'

G ntroduce a'ilit( drills

G Determine need "or ACL "unctional brace

*3 Continue all o" wee 0 *! stren'thenin' e


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ma( ta e u# to ! tablets. Do not crush or chew the tablets and do not e

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