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Early Physiotherapy For Anterior Cruciate Ligament (ACL) Reconstruction/Injury

Anterior cruciate ligament injury or rupture is a common sporting injury but also occurs in others situations where the knee is subject to significant force in certain positions.

Rehabilitation is important in many stages: after the acute injury, preparing for cruciate reconstruction, after reconstruction operation or when reconstruction is not planned and the person manages without their ACL.

Many people with this kind of injury, or partial tears, do not go on to have surgery and must rely on rehabilitating the knee so that is strong, stable and reliable in varied activities.

0-2 weeks

Regular pain control is very important, as pain interferes with natural muscle function and can inhibit speedy recovery. If you are prescribed medications, take them as you are advised and don’t think you can do without them too soon. They help your rehab.

Use of the ice or cryocuff cold/pressure device reduces the swelling and pain from the injury or the operation. Reducing the development of swelling may be more important than the pain, within reason.

Normal weight bearing on the knee should be established as soon as possible, although using crutches for two weeks after operation prevents too much stress being put on the new graft too early.

Understanding of the principles of open and closed chain exercises is vital. To safeguard your graft or rehab your knee successfully you need to stick to closed chain exercises as these put much less stress in the direction of the ligament deficiency.

Typical exercises:

  • Heel hang to attain or maintain full extension. The ability of the knee to achieve full straightness is very important to normal function. Pain, muscle spasm or an acquired stiffness can prevent this. To prevent this problem the foot is placed up on an object such as a stool with the knee hanging in mid-air. This stretches the back of the knee and allows the knee to relax into extension.
  • Quadriceps exercises to re-establish muscle control of the knee. Knee muscle tensing can be done frequently with the knee straight.
  • Active bending of the knee regularly to get knee flexion back.
  • Joint position sense – encouraging normal transfer of weight onto the operated leg.
  • Keeping the patella mobile by moving it side to side and up and down prevents any loss of movement of this bone against the femur.
  • Calf stretches to prevent stiffness in the ankle and the knee.

The Aim At 2 Weeks

At two weeks the knee should achieve certain points:

  1. 90 degrees knee bend.
  1. Full extension – a fully straight knee.
  1. The ability to balance easily on the operated leg.
  1. An absence or good reduction in swelling.
  1. The ability to do without the crutches and walk relatively normally.

Rehabilitation is fast in ACL reconstruction, with many people getting going well on the first day after operation. Is important to follow the protocol as the months go by and not to do strenuous activities too early which could lead to a stretching of the new ligament.


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