ACL REHABILITATION

Screening criteria for func- tional performance testing 1. No pain 2. No effusion 3. No crepitus 4. Full active range of movement 5.Symmmetrical gait including stair ascent and descent 6. Lower limb extensor muscle strength (isokinetic eccentric and concentric) LSI ≥ 85% 7. 1RM single leg press LSI ≥ 125% 8. Isometric 1/4 and 1/2 squat ≥ 45 sec- onds with eyes closed or open

References 1. Bollen S. Ligament injuries of the knee limp- ing forward? Br.J.Sp.Med. 1998;32(1):82-84 2. Riemann B, Caggiano N, Lephart S. Examination of a clinical method of assessing postural control during a functional perfor- mance task. J.Sports Rehabilitation 1999;8(3):171-183

Lee Herrington is a chartered physiotherapist and a lecturer in sports physiotherapy on the Manchester Metropolitan University MSc course. He is clinical specialist in sports injuries at the BUPA Murrayfield Hospital, Wirral and has a specific interest in post sur- gical knee rehabilitation and anterior cruciate reconstruction.

Week Rehabilitation goal and landmark 2

1 Full quadriceps activation 2 0-120º knee flexion 3 Minimal joint effusion (particularly in the morning) 4 Full weight bearing 5 Functional activity – cycling

6

1 Full range of movement 2 Minimal activity related effusion 3 No gait abnormalities (walking) 4 Unilateral CKC squat & step up 5 Bilaterally equal proprioception test

12

Note:

this timetable is only a guide and consultation with the referring orthopaedic surgeon is essential, when setting the time goals

1 Isokinetic test (flexors & extensors, eccentric & concentric) 2 LSI* (85% flexors, 60% extensors) 3 1 & 10RM leg press/squat (LSI 75%) 4 Bilaterally equal strength of hamstrings, gastrocnemius, hip adductors 5 Bilaterally equal proprioception test** on trampet/wobble board 6 Functional activity – jogging

24 1 Satisfied criteria for functional testing (Table 2)

(6 mths) 2 Hop test 3 Multiple single hop stabilisation test*** 4 Barrow zig-zag run*** 5 Sport specific function tests

* LSI = Limb symmetry index (measurement of side to side equality), divide mean of involved leg by mean of uninvolved leg x100

** Proprioception test = Single leg stance, hands on pelvis looking ahead, time until either the hands are removed from the pelvis or the other leg touches floor or move off the original spot. Time eyes closed and open

*** Instructions for multiple single hop stabilisation test and Barrow zig-zag run please refer to prac- titioner prompt sheet

Table 1: ACL reconstruction rehabilitation goals and landmarks

16 SportEX