ACL Rehabilitation

ACL Rehabilitation: Overview

Historically, the quoted time frame for return to pivoting, twisting and high-level sport is 9-12 months following reconstructive surgery. However, I support current evidence suggesting a GOAL-based rehabilitation program is superior to TIME-based rehabilitation. Despite this, we know that putting too much strain on the ACL graft too early in the recovery phase is associated with repeated injury. As a result, a balance between these two methods will achieve optimal results.

ACL Rehabilitation: Pre-operative Rehabilitation (‘Prehab’)

Pre-operative rehabilitation is essential to maximise your results following Anterior Cruciate Ligament (ACL) Reconstruction surgery. Most patients following their initial ACL injury will have a significant amount of pain or swelling in their knee, and a lot of patients will find it difficult to put their full weight through their knee in the early period after injury.

Prehab guided by your treating physiotherapist can provide the optimal advice regarding the early recovery from your ACL injury. Whether you choose to undergo reconstructive surgery or not, physiotherapy-led prehab is useful in preparing your knee for the next stage of your treatment.

ACL Rehabilitation: PRICE

Remember the following principles

P – Protection is meant to prevent further injury. Using crutches in the days following your ACL injury will help rest the knee and prevent it from collapsing on you while you recover. Once the diagnosis is made, and as long as there aren’t other injuries in the knee that require you to use crutches, you can start to progressively increase the amount of weight you put through your knee.

R – Rest is important to allow the knee to recover from the initial trauma of the episode. Once you’ve started to recover from the initial injury, you will be able to resume your regular day-to-day activities and commence light exercises such as stationary cycling. It is a good idea to regain the range of motion in your knee as soon as feasible, focusing on getting the knee straight again and bending beyond 90 degrees.

I – Ice. This is crucial in reducing the swelling in your knee and enabling you to regain your range of motion. One of the simplest ways of doing this is to use a bag of crushed ice (ice pack or frozen peas), wrapped over the knee with a bandage for 15-20 minutes every 1-2 hours.

C – Compression is the use of a compression wrap to minimise swelling and will also provide gentle support to the knee. Tubigrip is readily available from your local pharmacy, or alternatively, a compression bandage can be wrapped around the knee to achieve a similar result.

E – Elevation is key in reducing swelling in the recently injured knee. It is important to raise the knee above the rest of the body. In practice, this means laying down on a bed or couch and having the knee propped up on pillows so it sits above the rest of the body. Remember, the knee has to be above the level of your heart to achieve an appropriate amount of elevation.

ACL Rehabilitation: Post-Operative Rehabilitation

I believe a multi-disciplinary approach to your rehabilitation will optimise your chances of a successful recovery from ACL Reconstructive surgery. In general, this means input from myself, your physiotherapist, GP and most importantly you! I believe in an individualised treatment protocol for my patients, to identify their individual goals and then develop a plan to achieve them. Each treatment regime is patient-specific, but in general the stages of post-operative recovery include:

1. Acute post-operative recovery
2. Muscular control and co-ordination
3. Proprioception and agility
4. Sport specific training
5. Safe return to play

Phase 1 (0-2 weeks post op) goals:

• Get comfortable – pain relief as necessary
• Achieve wound healing
• Restore range of motion – aim to achieve near full extension
• Establish muscular control
• Wean crutches

Phase 2 goals:

• Re-establish normal walking patterns
• Reduce post-operative swelling
• Restore range of motion – full extension with flexion above 90 degrees
• Develop muscular control and endurance
• Work on core strength

Phase 3 goals:

• Improve balance and proprioception (joint position sense)
• Continue to work on muscular strength and introduce power
• Develop confidence
• Progress to gentle running, and then gradual change of direction
• Increase stamina
• Improve core strength

Phase 4 goals:

• Improve confidence
• Sport specific training and drills, commencing with low-risk activities and progressing under the guidance of your therapist / strength and conditioning team.
• Work on landing, jumping and change of direction mechanics
• Gradual introduction to training in a team environment
• Redevelop stamina and reduce muscular fatigue

Phase 5

• Higher level sport specific skills
• Gradual re-introduction to full training
• Commence game simulation
• Prepare for full return to sport
• Pass return to sport guidelines