ACL surgery
rehab
protocol
About half of all injuries to the anterior
cruciate ligament occur along with damage to
other structures in the knee, such as articular
cartilage, meniscus, or other ligaments.
The anterior cruciate ligament can be
injured in several ways:
• Changing direction rapidly
• Stopping suddenly
• Slowing down while running
• Landing from a jump incorrectly
• Direct contact or collision, such as a
football tackle
Treatment
• ACL tear treatmant vary depending on the patient's
individual needs, but surgery is often requiered. In this
presentation I will provide some phases that the
athlete's must done after surgery which will determine
their RTP(return to play) time.
PHASE I: Post-op (0-2 weeks
after surgery) after surgery)
• The goals in this phase is to: protect graft, prevent
swelling, minimize pain, restore patellar mobility, restore
full extension in the knee, improve flexion, minimize
muscle inhibition, re-establish quad control, regain full
active extension, and educate the patient of the whole
process that is ahead of him till the last phase.
Phase II: Intermediate post-
op (3-5 weeks after surgery)
• The rehabilitation goal is to continue protect graft,
restore ROM, maintain full extension and normalize gait.
For increasing ROM we start by adding a stationary bike,
and gently start stretching the quad muscle and the hip
flexor.
• We also include strenghtening and proprioreception
exercises like: standing hamstring curl, step ups, step
downs, partial squat, wall slides, single leg
balancing,lateral stepovers etc..
• The criteria to continue the progress is if there is no
swelling, flexion ROM within 10 degrees contra lateral
side, and extension ROM equal to contra lateral side.
Phase III: Late post-op (6-8 weeks after
surgery)
• The rehabilitation goals are to continue protect graft, maintan full ROM, safely progress
strenghtening, promote proper movement patterns, avoid post-exercise
swelling/pain,avoid activities that produce pain at graft donor site.
• We are increasing ROM, and also we include cardio and strenghtening exercises. The
following exercises are to focus proper control with emphasis on good proximal
stability: Box squat, lateral lunges, romanian deadlift, seated leg extension, and single
leg progression with weights, single leg press, step ups with march, single leg
squats, leg wall slides etc..
• The criteria to progress is no pain/swelling after the exercise, normal
gait, ROM equal to contra lateral side, and symetrical joint position sense.
Phase IV: Transitional (9-12 weeks after surgery)
• Rehabilitation goals: maintain full ROM, safely progress strenghtening,
promote proper movement patterns, avoid exercise pain/swelling,
avoid activities that produce pain at graft donor site.
• Continue with phase II and III exercises patterns and start sub-max
specific training in the saggital plane and include
bilateral plyometrics.
• Criteria to progress: full stability, maintain quadriceps strenght, 10x
reps on single leg squat at least at 60 degrees knee flexion, vertical
drop jump with good control.
Phase V: Early return to sport
(3-5 months after surgery)
• Rehabilitation goals: safely progress strenghtening, safely initiate sport specific training program, promote
proper movement patterns, avoid post exercise pain/swelling, avoid activities that produce pain at graft
donor site.
• With all those strenghtening progress we start with interval running and progress to plyometrics and agility .
• Agility and plyometrics program include 3 phases:
1.Anterior progression phase (forward run,backward run, circle run,figure 8 run, double leg jumps, single leg
jumps)
2.Lateral progression phase (side shuffle, carioca, crossover steps, zig-zag run,ladder, lateral jumps over
line/cones both leg and single leg)
3.Multi-planar progression phase.( box drill, star drill, side shuffle with hurdles, box jump with quick change of
directions, 90 and 180 degree jumps)
Phase VI: Unrestricted return to
sport (6+ mohtns after surgery)
• Rehabilitation goals: continue strenghtening and
proprioreceptive exercises, symmetrical performance
with sport specific drills, safely progress to full sport.
• Additional interventions: multi-plane sport specific
plyometric and agility programs, include hard cutting
and pivoting depending on the individual goals, non-
contact practice, full practice and full play.
Conclusion
From all of the above, we can say that the athletes nowadays has
maximized the resources to return to play as soon as possible after a knee
surgery, keeping in mind that there is a lot of evolution in the standards
and the access to the rehabilitation program from a scientific point of
view. The affected athlete can now return to play after 6-7 months of
rehabilitation program which was not the case in the past, when some
athletes have ended their careers after injuries of this type. Regardless of
that, the acces of physical rehab programs are including not only to
strengthened the muscles immediately above and below the knee such as
the quadriceps, hamstring and calf complex but also to have improve the
strength of your foot musculature, and the muscles around the hip and
core. Achieving excellent strength throughout the whole kinetic change
will mean you are more likely to have a positive return to sport activities.
