ACL Reconstruction

1
ACL Reconstruction
2
Preoperative Rehabilitation

• Maintain full ROM, retard atrophy, reduce pain
  and inflammation, maintain NM control
• Flexibility
• Strength
• NM Control
• CV maintenance

3
ACL Graft

• Undergoes necrosis and remodeling
• Revascularizes at 8-10 weeks, completed in 16
  weeks
• Cellular proliferation 4-8 weeks
• Graft to firmly attach to bone 8 weeks
• 1 year before graft appears histologically normal

4
Rehabilitation Programs

• Accelerated and Delayed Programs

5
Accelerated Program

• Post-op
• Bracing at all times except during rehabiliation
• Set a zero degrees extension
• WB as tolerated
• Cold Modalities
• CPM
• Foot and ankle movements
• Quad isometric setting
• SLR in all directions
• Patellar Mobilizations
• Heel Slides

6
Accelerated Program

• 1-2 weeks post-op
• Goals
• Minimal swelling (cryocuff, compression, rest)
• Increase ROM to 0-90 degrees
• Increase strength to begin CKC activities
• Weight bearing as tolerated with or without
  crutches

7
Accelerated Program

• 1-2 weeks post-op
• Electrical Modalities
• Leg at 0 degrees of extension
• CPM until reach 90-110 degrees
• Discontinue bracing if strength permit
• Will continue to use brace
• CKC exercises
• Mini squats 40 degrees to full extension
• One legged mini squats 30 degrees to full
  extension
• Step-ups
• Toe Raises
• Hamstring Curls
• Active assisted progressing to AROM and RROM

8
Accelerated Program

• 3-4 weeks post-op
• Goals
• Full weight bearing
• Proper gait control
• Increase ROM 0-120 degrees
• Increase strength
• CKC exercises only for quads
• Encourage Leg control
• Cardiovascular training can begin

9
Accelerated Program

• 3-4 weeks post-op
• Tibiofemoral joint mobilizations
• If needed
• CKC exercises
• Add in static standing activities
• One legged stork standing
• Leg Extensions (90-45 degrees)
• Leg Press (45-0 degrees)
• Hamstring strengthening
• Toe Raises
• Ski machine, treadmill walking, stair master (lt4
  in step)
• Good opportunity to introduce aquatic therapy

10
Accelerated Program

• Weeks 5-12
• Goals
• Continue increasing flexibility
• Continue strengthen quads CKC only
• Continue strengthening hamstrings
• Continue to facilitate Neuromuscular control
  training
• Continue improving CV abilities

11
Accelerated Program (Weeks 5-12)

• Stretching
• Hamstring, quads, Achilles Tendon
• Strengthening
• Hamstring curls
• Biodex Hamstring Only (concentric and eccentric)
• Leg Press
• 6 weeks (90-30)
• 8 weeks (90-15)
• Squats
• Leg Extension
• 10th week 90-full
• Toe Raises

• Neuromuscular Control
• 6th week begin dynamic activities
• Trampoline, cup drill, balance disc
• Balance squats w/ ball toss
• Eyes open/closed
• Slide board
• Cardiovascular
• Treadmill walking
• Treadmill jogging (depends on physician)

12
Accelerated Program (Weeks 13-24)

• Goals
• Continue to increase strength, power and
  endurance
• Continue Restoration of Cardiovascular System
• Further neuromuscular control training
• Progress from general sport movements to sport
  specific

13
Accelerated Program (Weeks 13-24)

• Stretching as needed
• Strengthening
• Hamstring curls (single leg)
• Biodex (Hamstring only)
• Gastroc exercises
• Leg Press (full ROM)

• Neuromuscular
• Balance with ball toss
• Fitter
• Agility
• Figure 8s
• Zig-zags
• Strides
• Cardiovascular
• Jogging can begin
• Sport cord jogging
• Stadium runs
• Begin sport specific activities

14
Accelerated Program (6-9 months)

• Goals
• Increase strength, power and endurance to 90
  uninvolved leg
• Increase running and cutting to meet demands of
  individual sport
• Increase CV demands to meet demands of sport
• Progress to partial or full sport activities

15
Accelerated Program (6-9 months)

• Biodex testing (180 - ten reps, 300 15 reps)
• Return to activity drill
• Agilities
• Plyometric program
• Gastroc exercises
• Squats
• Leg curls
• Sprint progression

16
Accelerated Program (9-12 months)

• Maintenance and work on any deficiencies