Knee Treatment

ACL Rehab Phase 1 | Post-Op Exercises

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ACL Rehab

ACL Rehab Phase 1 | Anterior Cruciate Ligament Post-Op Exercises

The goal in the first stage of rehabilitation is regaining normal joint function and you should be focussing on decreasing swelling, reaching full extension, reaching normal patellar-femoral joint motion, selective quadriceps control, and normal walking gait. (In een table naast Kirsten)

You can start with mobility exercises like heel slides and knee extensions with a towel underneath the backside of the knee. If needed you can mobilize knee extension or patellar-femoral joint manually. Patients need to use crutches until they can walk symmetrically. Cycling on an ergometer is allowed. The primary function of cycling in this stage is warm-up and/or mobilization. (show pendulum on the bike)

Isometric, concentric and eccentric exercises are allowed in this early stage in a closed chain. Be careful with open-chain exercises.  After four weeks they are allowed in a small range of motion from  90-45 degrees. Every week 10 degrees of extension can be added, so after 5 weeks you can do leg extensions from 90 to 35 degrees and a week later to 25 degrees etcetera. When the reconstruction was done with a patellar-bone-patella graft external resistance is allowed after four weeks. In a hamstring graft reconstruction, however, resistance is only allowed after 12 weeks.  These limitations are described due to the fact that in the early stage you don’t want to strain the new graft too much. In normal daily life, the graft will experience harmless strain already, during sitting and standing up from a chair and stair walking. In your training in the first 3-4 weeks, it’s safest to train in a range of 0-60 degrees of flexion in your squat and/or leg press exercises. Open chain exercises like active leg raises and side-lying abductions don’t strain the ACL and can be performed from the first week on. 

The ACL does not only have a mechanical function. 2,5% of the ligament is made up of mechanoreceptors, thus it has a neuromuscular function in the knee joint as well. These receptors are responsible for the detection of positional changes in the joint, like in end-range positions where they facilitate protective reflexes.  After an ACL injury, there is no new ingrowth of mechanoreceptors. Therefore, it is important to start with neuromuscular training like balance exercises in an early stage.

Now we’re going to demonstrate a couple exercises that can be used in the first stage of the rehabilitation:



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Escamilla RF, MacLeod TD, Wilk KE, Paulos L, Andrews JR. ACL strain and tensile forces for weight bearing and non—weight-bearing exercises after ACL reconstruction: a guide to exercise selection. journal of orthopaedic & sports physical therapy. 2012 Mar;42(3):208-20.

Meuffels DE, Poldervaart MT, Diercks RL, Fievez AW, Patt TW, Hart CP, Hammacher ER, Meer FV, Goedhart EA, Lenssen AF, Muller-Ploeger SB. Guideline on anterior cruciate ligament injury: a multidisciplinary review by the Dutch orthopaedic association. Acta orthopaedica. 2012 Aug 1;83(4):379-86.

Van Grinsven S, Van Cingel RE, Holla CJ, Van Loon CJ. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 Aug 1;18(8):1128-44.

van Melick, N., van Cingel, R.E., Brooijmans, F., Neeter, C., van Tienen, T., Hullegie, W. and Nijhuis-van der Sanden, M.W., 2016. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. British journal of sports medicine50(24), pp.1506-1515.

Risberg MA, Holm I, Myklebust G, Engebretsen L. Neuromuscular training versus strength training during first 6 months after anterior cruciate ligament reconstruction: a randomized clinical trial. Physical therapy. 2007 Jun 1;87(6):737-50.

Mark S, McDivitt R. Rehabilitation of patients following autogenic bone-patellar tendon-bone ACL reconstruction: a 20-year perspective. North American journal of sports physical therapy: NAJSPT. 2006 Aug;1(3):108.

Samuelsson, K., Andersson, D. and Karlsson, J., 2009. Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: an assessment of randomized controlled trials. Arthroscopy: The Journal of Arthroscopic & Related Surgery25(10), pp.1139-1174.

Wright RW, Preston E, Fleming BC, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Kaeding C, Kuhn JE, Marx RG, McCarty EC. A systematic review of anterior cruciate ligament reconstruction rehabilitation–part I: continuous passive motion, early weight bearing, postoperative bracing, and home-based rehabilitation. The journal of knee surgery. 2008;21(03):217-24.

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