POST OP ACL REHAB PROCESS
Keeping in mind that each ACL rehab is unique, and dependent on the type of surgery and graft as well, below is an outline on what the ACL Process should look like. You can read more about the different types of surgeries and their pros and cons here.
Phases of rehab Process
The pre-op phase consists of improving range, strength and reducing swelling should be the goal before surgery to improve outcomes after surgery.
Is the first few weeks after surgery. Any surgery is essentially trauma to the body and ACL reconstruction is no different. Whilst it’s tempting to dive right into the deep end, it’s best to let the knee settle for the first 1-2 weeks with basic range exercises, quadriceps setting drills, gait retraining, ice and compression. The main goal of this stage is to get the knee straight with full extension, reduce the swelling and maintain as much quadriceps strength as possible.
Neuromuscular control and strength. The goal of this stage is to regain strength, balance and co-ordination. An important thing to note during this phase is to keep the knee ‘quiet’. This means listening to the knee and only progress as the knee allows. his phase usually commences with easy body weight type exercises and progresses into a gym-based regime with a mixture of resistance, balance, and co-ordination exercises.
Although ACL rehabilitation should be more criteria based progressions rather than time base progressions, we usually see athletes progress into this running, agility and landings stage anywhere from 3-5 months. Again every athlete and every rehabilitation journey is different. During the commencement of this phase the knee should be swelling and pain free so that emphasis can be placed on correct technique particularly for deceleration tasks such as landing from a jump. During this phase Neuromuscular control and strength exercises should be progressed to challenge the athlete. It is important that jumping/landing technique is perfected before progressing to the next phase.
Research currently suggests that return to sport should be minimum 9 months as that is when the ACL itself is completely healed. A number of things must be considered before returning the athlete to sport including the athletes confidence, the strength and stability of the knee, as well as the patterning and the biomechanics not only of the knee, but the whole body. The progress of returning to sport must also be gradual starting with restrictions and eventually without.
This is a critical phase where each athlete must continue to maintain or even improve their confidence, strength and biomechanics. A program should be given on discharge that works on plyometrics, balance and strength.
The SportsFit 8 Stage ACL Rehab Program
This SportsFit ACL Rehab Program is our inhouse system developed to return those with an ACL injury back to performing better than they were before their injury.
Every person who comes in will have their program designed for them, broken up over 8 distinct stages over the course of 9 – 12 months.
You can read more about our ACL stats on our main website here
Pros and Cons of each type of graft
The best person to talk to about your graft type and the pros and cons is your surgeon. Below is an overview of the most commonly used graft
What is it?
An allograft is the tissue of a donor. The type of tissue typically depends on surgeon’s expertise and preference. Common allografts include semitendinosus/gracilis, peroneal tendon, patellar tendon.
Pros:
There is no donor site morbidity as there is in an autograft, meaning there is no further rehabilitation considerations that need to be made for the graft site
Typically may aid in resolving initial swelling and range of motion deficits given no donor site morbidity
Cons:
Tissue may not uptake as well in the knee as an autograft
Arguments may be made for higher risk of infection
Some studies say slightly higher rates of re-rupture – this varies on how the graft is prepared
What is it?
The middle portion of the patellar tendon is harvested and used as the ACL.
Pros:
No affect to the hamstring – reduces considerations for hamstring loading and high speed running
Native tissue typically uptaken well by body
Cons:
Typically slower to improve quadricep strength and control due to the role the patellar tendon plays in attenuating force
Can have more secondary patellofemoral pain during rehabilitation process
What is it?
Harvesting of the semitendinosus, and often the gracilis as well. Doubled over itself to provide a thicker graft, to use as the ACL.
Pros:
No affect to quadriceps, meaning initial rehab to get knee going is smoother
Most common graft used, so surgeon expertise is typically quite high with this
Cons:
Hamstring loading is slower to progress due to donor graft morbidity
High speed running has to be monitored closely to ensure no secondary hamstring injury