ACL Reconstruction & Rehabilitation

The goal of surgery is to restore joint anatomy, provide knee stability, as well as return to work and sport as soon as possible.

Some patients achieve satisfactory stability non-operatively. Long-term ACL deficiency may result in gradual damage to the menisci and articular cartilage.

ACL reconstruction is best performed once the knee has recovered from the initial injury, and full range of motion regained.

The damaged ligament is replaced by a graft; usually from the hamstring tendons (gracilis-semitendinosus) or middle third of patella tendon (bone-patella tendon-bone). The graft is passed through bone tunnels and fastened with screws or similar devices for fixation.

Patients generally spend a night in hospital, followed by a period rehabilitation to restore strength, motion, flexibility and proprioception.

The following is a guide to the stages of rehabilitation. They are designed to hopefully reach the best compromise between biological healing and accelerated recovery. If at any stage, recovery is complicated by swelling or pain, then rehabilitation should be slowed to aid resolution.

The actual rehabilitation process will vary slightly from person to person, and also depend on any additional surgery performed.

Before Surgery

• Please do not shave your legs
  Skin problems around the knee may cause a delay in surgery
• Advise us of any known allergies
• Bring any regular medications and all imaging performed to hospital

After Surgery

Day 1 & 2

• The knee is braced initially in extension to allow healing around the graft at the bone tunnels
• Regular ice to control swelling
• Maintain extension; pillow under heel NOT knee
• Protected weight bearing (25-50%) for first 7-10 days
• Static quadriceps contractions in extension; No active extension from 40 to 0 degrees allowed for 3 months
• Patella mobilisation with quadriceps relaxed; glides and tilts
• Opposite Leg Active Assist Leg Extension (OLAALE) for 6-12 weeks

Day 3 to 14

• Proprioception; single leg stance 2 times a day for a few minutes, using hands for balance
• Continued work on extension
• (Prone knee hangs and knee flexion)
• (Flexion exercises; prone / seated)

Week 2 to 6

• Achieve full range of movement
• Full weight bearing
• Proprioception; balance without hands / eyes shut / leaning side to side
• Closed kinetic chain exercises
• (Flexion exercises; prone / seated)
• Resisted hamstring exercises; low weight after 3-4 weeks
• Hamstring stretches
• Swimming; straight kick only
• Stationary bicycle riding; no resistance
• Co-contractions; lunges, 2 leg quarter squats

DRIVING
Patients should probably wait 6 weeks before driving if their “braking” leg has undergone surgery

Week 6 to 12

• Step lunges and half squats
• Proprioception; lateral stepping, wobble board
• Increase gym work resistance; leg press
• Eccentric hamstrings
• Swimming (no breaststroke)
• Progress to normal bicycle
• Jogging on flat

Month 3 to 6

• Proprioception; hopping, jumping, lateral movements
• Open chain quadriceps can commence
• Sport specific exercises
• Strength work; leg curls, half squats, wall squats, rowing machine
• Agility work; eg sideways running, skipping rope
• Return to training; non-contact drills
• Isokinetic testing; aim for quads to be 70% normal

Month 6 to 9

• Increase intensity of training, strengthening
• Isokinetic testing; aim for quads to be 90% normal between 6-9 months

Month 9+

Aim for return to competitive sport, based on strength, proprioception and symptoms.

These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances. Please contact Mr Kondogiannis' rooms if you require further information.