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ACL Rehabilitation

Rehab goals for the Anterior Cruciate Ligament (ACL) reconstruction:

  • Prevent/Eliminate swelling
  • Regain full range of motion
  • Regain good muscle control
  • Regain a normal gait pattern (walking)

Pre-op rehab

Time frames and exercises, described below, are general guidelines and will be tailored to meet individual progress.

Returning the knee to a normal state (except for the ACL tear) will speed up recovery time and allow goals to be more easily achieved.

Before scheduling surgery, the following conditions must be met:

  • full range of motion
  • little or no swelling
  • normal walking
  • appropriate strength

Rehab goals for the graft knee:

The graft knee does not swell after surgery so quadriceps strengthening exercises can begin on the day of surgery. Strengthening exercises help the tendon to rebuild and fill-in the area that was used for the graft. If the graft is taken from the same knee, strengthening exercises are started after full range of motion is regained and swelling goes away.

We monitor strength by performing a series of strength tests at regular intervals. The ultimate goal is to restore symmetric range of motion and strength that is equal to or better than the pre-operative values.

Day of surgery

Following surgery, a Cryo-Cuff® should stay on the ACL reconstructed knee at all times to prevent swelling (except during extension and flexion exercises). The ACL reconstructed leg will be placed in a continuous passive motion (CPM) machine, which is used to elevate the knee above the heart to reduce swelling.

Motion Exercises for ACL-reconstructed knee

  • Extension (straightening)
    • Heel props (perform quad sets at the same time)
    • Prop up opposite leg to make sure extension is equal
    • Towel stretches for full hyperextension (equal to graft leg)
    • It is absolutely essential that the ACL-reconstructed leg has full extension motion, equal to the opposite leg.
  • Flexion (bending)
    • Use the CPM machine to help with flexion
    • Pull ankle toward the buttocks (using hands) as far as possible
    • Measure flexion by using yardstick (centimeters)

Motion Exercises for Graft-donor knee

  • Extension

Graft-donor knee extension will not be affected and will be normal immediately after surgery.

  • Flexion
    • Heel slides
    • Measure flexion using yardstick (centimeters)

Strengthening Exercises for Graft-Donor Knee

  • Use the shuttle

Exercises for the ACL-reconstructed and Graft-donor legs may vary depending upon the ease of regaining and maintaining desired motion. Reaching full flexion and extension will speed up recovery.

One day post-op

  • Keep the ACL-reconstructed leg in the CPM machine at all times (except when doing exercises)
  • Remain in bed with ACL-reconstructed leg elevated above heart
  • When walking (to bathroom only), put as much weight on the ACL-reconstructed leg as tolerated
  • Putting weight on the ACL-reconstructed leg will not affect the reconstruction; however, being up too much with the knee below the level of the heart may cause swelling and problems with recovery

The patient must have the following to be released from the hospital:

  • Full extension of the ACL-reconstructed leg equal to the graft-donor leg
  • Flexion of at least 120 degrees on the ACL-reconstructed leg and full flexion on the graft-donor leg
  • Ability to lift both legs with leg muscles
  • Ability to walk without assistance
  • Understanding of the home instructions for the next week

Days 1-7 post-op

  • Remain in bed with ACL-reconstructed leg elevated above heart
  • Keep the ACL-reconstructed leg in the CPM machine
  • Maintain full extension on the ACL-reconstructed leg
  • Maintain at least 120° of flexion on the ACL-reconstructed leg
  • Maintain full flexion on the graft-donor leg
  • Use the shuttle to work on increasing strength on the graft-donor leg

Days 7-14 post-op

Most patients are able to gradually resume their normal daily activity out of bed during this week. Activity level will be determined by the condition of knees (activity increases as knee progresses).

ACL-Reconstructed Leg:

  • Maintain extension
    • lock knee straight while standing
    • heel props
    • prone hangs
    • towel stretches
  • Flexion should be at least 135°
    • heel slides
    • wall slides
    • flexion hangs
  • Decrease swelling
    • use Cryo-Cuff® as needed
  • Graft-donor leg
    • maintain full extension and full flexion
    • increase strength
    • step down exercise

Two to four weeks post-op

During weeks 2-4, more emphasis is placed on strengthening the graft knee. Patients also continue working on ACL knee range of motion.

  • leg press
  • knee extension (replaces shuttle)

The patient’s therapist or athletic trainer will design an individual rehabilitation program according to the patient’s needs and goals.

Two to twelve months post-op

Physical therapy will continue as the patient returns to their preoperative, fully competitive level of activity. Strength, range of motion, and swelling will be evaluated at each visit. Rehabilitation and sporting activities will be advanced as strength, comfort, and confidence allows.

Follow-up visits are typically every 1-3 months depending on your progress. After the first year, follow-up visits (at no charge) at two, five, ten, fifteen, and twenty years after surgery are requested for research purposes and are essential for the ongoing study of ACL reconstruction.