PRACTITIONER PROMPT ACL reconstruction rehabilitation

REHABILITATION KEY POINTS - Early rehabilitation emphasises a) minimising inflammation response to surgery b) obtaining full knee extension as soon as possible to avoid fat pad contracture

- Patellar mobilisations can also assist in reducing contracture risk - Minimise the use of crutches. If good quadriceps control and gait pattern, the author advises full weight bearing from day one

ACL RECONSTRUCTION REHABILITATION PROTOCOL Brace (when weight bearing) Weight-bearing (normal gait pattern)

Can stop crutches as soon as has good gait pattern.

ROM (minimum goal)

Stretching Heel hangs

Patella mobilisations

Strengthening Isometric quads, SLR

wall slides, toe standing, leg press) Hamstring curls

Open chain knee extension

Cardiovascular Stationary bicycle

Step machine/swimming – straight kicks Running - straight

Proprioception (eg. weight transfers,

balance board, mini tramp) Dynamic stability (eg. step on/off differ-

ent surfaces in all directions) Sport specific/agility drills

(eg. shuttle runs, cariocas, figure 8s) Plyometrics

(eg. bounding, hopping, jumping) Activities Work – sedentary Work – heavy Driving

Full sports

Extension Flexion

Oedema management (RICE) 0

90 ✓

0 135 As reqd

Hamstrings, calf, ITB, quadriceps ✓✓ ✓✓

✓✓

Active knee flexion/extension (foot sliding) ✓✓ Closed chain (gait re-ed, mini squats, ✓✓

✓✓ 90-30 90-30 Hip extension, abduction, adduction ✓✓ 0 135 As reqd

✓✓ As reqd ✓ ✓

✓ ✓ ✓

✓

90-30 ✓

0 135 As reqd

As reqd ✓

As reqd

✓ ✓ ✓

✓

90-30 ✓

✓✓ ✓ ✓✓

✓✓ ✓ 0 135 As reqd

As reqd ✓

As reqd

✓ ✓ ✓

✓

90-0 ✓

✓ ✓

✓✓ ✓

✓✓ ✓ 0 135 As reqd

As reqd ✓

As reqd

✓ ✓ ✓

✓

90-0 ✓

✓ ✓ ✓ ✓

✓ ✓* ✓✓ ✓* ✓✓ ✓✓ ✓

✓** ✓✓ ✓✓

✓ ✓**

✓ ✓ ✓ ✓

† WBAT - weight-bearing as tolerated * Progressed within limits of pain, swelling and muscle control. **Dependent on type of employment/sport

www.sportex.net 15

1-2 x

WBAT †

POST OP WEEK 3-6 x

FWB

6-12 x

FWB

3-6 x

FWB

POST OP MONTH 6-9 x

FWB

9+ x

FWB

- From week 3 onwards work introduce proprioception to the strengthening and stretching elements of the rehabilitation

- Final stages emphasis restoration of agility (neuromuscular control) and strength

- Return to sport is advised after around 6 months although it may take another year for players to regain their peak

- Early supervision and input from physiotherapists is essential - good quality physiotherapy makes all the difference.