ACL and collateral ligament reconstruction

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Post-op recovery First 2 weeks Date

Goals

  • Protect the knee and surgical incisions
  • Recover from swelling and inflammation
  • Control of post-surgical pain

 

Precautions

  • Fully weight-bear but use crutches for support and to improve gait

 

Brace

  • Locked in extension when mobilising
  • Unlock brace at rest and when doing ROM exercises
  • At rest the brace can be loosened to allow swelling and discomfort to settle
  • Sleep in brace (locked in extension)

 

Recommendations

  • Rest and elevate as required
  • Ice the knee up to 3 times a day – particularly in the first 72 hours
  • Range of motion exercises of ankle
  • Range of motion exercises of hip
  • Gentle movement of the knee from full extension to 90 degrees of flexion as pain and swelling allows
  • When walking with crutches – concentrate on achieving heel strike, role through and toe off
  • When standing, push both knees back straight to help achieve full extension

 

Exercise suggestions

  • Static quads contraction
  • Supine straight leg raise
  • Ankle pumps
  • Supine bed supported knee bend
  • Sitting supported knee bend
  • Sitting knee extension stretch – foot on floor
  • Supine knee extension – foot elevated/supported
  • Standing knee extension
  • Side leg raise – knee straight in brace
  • Double calf raises

 

Criteria for progression

  • Healed surgical incisions

 

Phase 1 Week 2 to week 6

Goals

  • Increase ROM
  • Begin strengthening
  • Normal gait
  • Minimal Pain
  • Minimal Swelling

 

Precautions

  • Keep using crutches and wearing brace

 

Brace

  • Locked in extension when mobilising
  • Unlock brace at rest and when doing ROM exercises
  • At rest the brace can be loosened to allow swelling and discomfort to settle
  • Brace can come off to sleep

 

Recommendation

  • When standing, push knees back straight to help achieve full extension
  • When walking – concentrate on achieving heel strike, role through and toe off
  • Increase range of motion from full extension to full flexion
  • Hip and gluteal muscle strengthening
  • No gluteal band exercises – protect collateral ligament repair
  • Ankle range of motion and strengthening

 

Exercise suggestions

  • Low load, long duration (assisted as required)
  • Wall slide mini squat
  • Double leg squats (0-60)
  • Sitting unsupported knee extension and flexion
  • Single leg stance – knee straight, knee flexed
  • Straight leg raise
  • Step ups
  • Double calf raises – progress to single calf raise
  • Side leg raise – knee straight in brace
  • No gluteal band exercises – protect collateral ligament
  • Bridging with gluteal contraction

 

  • Exercycle – low resistance, short interval
  • Cardio:
  • Swimming (freestyle or backstroke only), Hydrotherapy, Stationary bike cycling, Upper body weight training (must be seated or lying)

 

Criteria for progression

  • No active extension lag, 110º active flexion
  • Minimal effusion/pain
  • Normal Gait
  • Functional strength and control in daily activities

 

Phase 2 Week 7 to week 12

Goals

  • Gain full range of motion
  • Muscle strengthening
  • Neuromuscular control
  • No swelling
  • No pain

 

Precautions

  • Wean off crutches as soon as able
  • No running until week 12 if meeting all criteria

 

Brace

  • Fully unlock brace at all times
  • Brace worn only for mobilising
  • Brace can be discarded after week 8

 

Recommendations

  • Fully weight bear as able
  • Passive stretching to achieve full extension and flexion
  • Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Neuromuscular control and co-ordination of leg

 

Suggested exercises

  • Double leg squats (0-90)
  • Single leg squats
  • Single leg hop
  • Step ups – increase height
  • Step downs
  • Resisted quads and hamstring weight training
  • Gluteal band exercises
  • Bridging with gluteal contraction
  • Double calf raises – progress to single calf raise
  • Exercycle – increase resistance and training length
  • Neuromuscular Training: Wobble board, rocker board, roller board, Varied surfaces

 

  • Cardiopulmonary: Bike, Elliptical trainer, Stairmaster, swimming 

 

Criteria for progression

  • Walking 20 minutes without pain or swelling
  • Neuromuscular and strength training exercises without difficulty
  • Full ROM

 

Phase 3 3 Months – 6 months

Goals

  • Running on flat surface
  • Jumping (double leg)
  • Hop Tests 75% of contra-lateral side
  • Hopping without pain, swelling, or giving way

 

Precautions

  • Run on flat stable surface in daylight
  • No pivoting or cutting activities or sports

 

Recommendations

  • Passive stretching to achieve full extension and flexion
  • Concentrated full rehab program that includes strengthening of core, hip flexors, gluteal muscles, external rotators of the hip, quadriceps, hamstrings and calves. Neuromuscular control and co-ordination of leg

 

Suggested exercises

  • Running on flat even surface. Gradually increasing distance
  • Aggressive strength training Hamstrings, Quads, calves, adductors, abductors, core strength
  • Cycling with high resistance (standing permitted)
  •  
  • Neuromuscular Training: Wobble board, rocker board, roller board, varied surfaces
  • Begin gentle pivoting and direction changing

 

  • Cardio:
  • Running, swimming, cycling,stair climber, elliptical trainer

 

Criteria for progression

  • Maximum vertical jump without pain or instability
  • 75% of contralateral on hop tests
  • Run at 75% speed without difficulty
  • Some confidence with pivoting and changing direction

 

Phase 4 6 Months – 12 months

Goals

  • 100% contralateral strength
  • 85% contralateral on hop tests
  • Running without pain
  • Absolute confidence with pivoting and turning

 

Precautions

  • NO pivoting or contact sports
  • Can return to non-competitive non-contact sport training

 

Recommendations

  • Gain and maintain endurance and strength
  • Sport specific functional training
  • Graduated return to cutting and pivoting movements
  • Neuromuscular control and coordination

 

Suggested exercises

  • Running on flat even surface. Sprinting. Direction changes
  • Aggressive strength training Hamstrings, Quads, calves, adductors, abductors, core strength
  • Cycling with high resistance (standing permited)
  • Hopping, jumping
  • Pivoting and direction changes
  • Begin cutting (non-competitive environment)

 

  • Cardio:
  • Running, swimming, cycling, stair climber, elliptical trainer

 

Criteria for progression

  • Return to sport criteria
  • -One year post reconstruction
  • -No functional complaints
  • -Confidence when running, cutting, jumping at full speed
  • -85% contralateral values on hop tests

 

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