ACL Reconstruction with meniscus repair

Download PDF

Post-op recovery First 2 weeks Date

Goals

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

 

Precautions

  • Non-weight bearing on crutches

 

Brace

  • Locked in extension
  • At rest the brace can be loosened to allow swelling and discomfort to settle
  • Sleep in brace

 

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

 

Exercise suggestions

  • Static quads contraction
  • Supine straight leg raise
  • Side leg raise
  • Ankle pumps
  • Supine knee extension – foot elevated/supported

 

Criteria for progression

  • Healed surgical incisions

 

Phase 1 Week 2 to week 6

 

Goals

  • Begin range of motion – gentle
  • Begin strengthening hip and core

 

Precautions

  • Non-weight bearing on crutches
  • The foot may rest on the ground when stationary

 

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) weeks 3-4
  • Sleep without brace weeks 5-6

 

Recommendation

  • Gently move knee from 0 – 90 degrees (wear brace but unlock). No resistance, no strengthening
  • Hip and gluteal muscle strengthening
  • Ankle range of motion

 

Exercise suggestions

  • Static quads contraction
  • Supine straight leg raise in locked brace
  • Ankle pumps
  • Supine bed supported knee bend
  • Sitting supported knee bend
  • Supine knee extension – foot elevated/supported
  • Side leg raise – knee straight in locked brace

 

Phase 2 Week 7 to week 12

Goals

  • Comfortably walk normally
  • Increase range of motion

 

Precautions

  • No running
  • No deep squats (including kneeling, crouching down to or sitting on floor)
  • No forced high flexion of the knee (0-100 degrees only)

 

Brace

  • No brace required

 

Recommendations

  • Gradually begin taking weight through your leg when you walk. Fully weight bear as able
  • Discard crutches when walking safely
  • Achieve full extension – passive and active
  • Flex actively as comfortable, but no forced high flexion (0-110)
  • Gluteal and hip strengthening
  • Ankle and calf strengthening
  • Short walks

 

Suggested exercises

  • 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, knee flexed
  • Gluteal band exercises
  • Bridging with gluteal contraction
  • Exercycle – low resistance, short interval

 

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

 

Back