ACL rehabilitation
Considerations Before Setting up a Plan:
Acute Phase:
In the acute management phase, there are some considerations to protect the surgical repair and allow healing without compromising ROM.
Protection and Restrictions:
ROM:
Patient can move freely either actively or passively throughout the available ROM within pain tolerance.
Bracing:
Bracing may not be beneficial on the long run, some clinicians prefer placing the knee in an immobilising brace which is then replaced with a c-hinge functional knee brace once femoral nerve block wears off following the surgery.A safer environment may not require bracing.
Weight-Bearing:
While full weight-bearing may be tolerated in the first few weeks, partial weight bearing is preferred to protect scarring, allow healing and restore joint homeostasis as soon as possible.
Stationary bike:
Introduced on day 10 or once 110° knee ROM is achieved. However, you may permit a small range of pelvis rocking as a way of facilitating ROM if the whole range is still restricted.
Resistance weight-bearing strength training:
Delayed until 6 weeks after surgery to avoid scar hypertrophy and stiffness.
The intermediate rehabilitation phase goals:
Knee flexion within 10° of the contralateral side.
Quadriceps index greater than 60%.
Quadriceps Index is :’'the ratio of involved-side quadriceps strength to uninvolved-side quadriceps strength".
Late rehabilitation phase goals:
Quadriceps index greater than 80%
Normal gait pattern
Full knee ROM
Knee joint effusion equal to a grade of trace or less.
Assessed using the modified stroke test.