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Pre- and post-surgery physical therapy for ACL reconstruction is necessary to reduce the risk of complications, reduce recovery time, and ensure a full recovery.
What is the ACL?
The ACL, the anterior cruciate ligament, is a strong band of tissue that connects the thigh bone (femur) to the shinbone (tibia). An ACL injury may occur during sports that require sudden stops or changes in direction, and jumping and landing, such as basketball, soccer, football, and skiing.
When an ACL injury occurs, a person may hear a pop or feel a popping sensation in the knee. Immediately after the injury, the knee may swell, feel unstable, and struggle to bear weight under immense pain. Other symptoms of an ACL injury include loss of range of motion and an inability to continue athletic activity.
Who Needs Surgery?
An ACL reconstruction may be necessary if:
- More than one ligament is injured
- The meniscus is torn and requires repair
- The injury is causing the knee to buckle during everyday activities
- The injured individual is an athlete who wants to continue playing their sport
The risks of surgery include knee pain or stiffness, poor graft healing, and graft failure after resuming athletic activities.
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What to Expect During Physical Therapy
Immediately after surgery, the goals of rehabilitation include protecting the graft, reducing swelling, minimizing pain, restoring patellar mobility and full extension, improving flexion, and minimizing arthrogenic muscle inhibition. The physical therapist will also provide the patient with instructions for walking in a brace and managing the swelling.
A few exercises the patient will be taught to perform include:
- Patellar mobilizations
- Seated assisted knee flexion extension
- Heel slides with towel
- Prone hang
- Heel prop
- Standing gastroc stretch
- Soleus stretch
- Patellar mobilizations
- Seated assisted knee flexion extension
- Heel slides with towel
- Prone hang
- Heel prop
- Standing gastroc stretch
- Soleus stretch
During the second phase of rehabilitation, the patient will perform the following exercises:
- Riding a stationary bicycle
- Gentle stretching: prone quad stretch, standing squat stretch, and kneeling hip flexor stretch
- Prone hamstring curls
- Step-ups and step-ups with a march
- Partial squats, ball squats, and mini squats
- Wall slides
- Bridges
- Side lying hip external rotation-clamshell
- Hip hike
- Single leg standing balance
- Lateral step-overs
- Joint positioning re-training
The third phase of rehabilitation, six to eight weeks after surgery, will involve cardio: elliptical, stair climber, flutter kick swimming, and pool jogging. Patients will also perform exercises on the following machines: leg press machine, seated hamstring curl machine, hamstring curl machine, hip extension machine, hip abductor and adductor machine, and seated calf machine. Other exercises patients will do include:
- Squat to chair
- Romanian deadlift
- Lateral lunges
- Knee exercises
- Partial weight bearing single leg press
- Slide board lunges
The following phases of rehabilitation will focus on promoting proper movement patterns, continuing strengthening and proprioceptive exercises, supporting symmetrical performance with sport specific drills, and ensuring the patient is able to safely progress to full sport.
Upon successfully completing pre- and post-surgery physical therapy for ACL reconstruction, patients should be able to play their sport without any pain, swelling, or restrictions in range of motion.
