good physical therapy program will focus on rehabilitation of the
knee in two areas:
Strength - The muscles surrounding
the knee, particularly the hamstring muscles, must be strengthened.
These muscles can then take on some of the ACL's job of stabilizing
the knee joint.
Proprioception - Proprioceptive
nerves in the ligament send important information to the brain
about where the body is in space. The brain then sends information
to the muscles to tell them how to move the joint. The damaged
nerves in the ligament must be retrained so that the muscles will
move the joint properly.
A functional ACL brace will
usually be prescribed to stabilize the knee and to prevent reinjury.
Most functional braces incorporate a rigid frame. A trained specialist
will fit the patient with the brace since a good fit is essential.
Modern functional braces are lighter and much less bulky than older
models. Patients find them easy to apply and comfortable to wear.
Following surgery, the patient will be started on a structured
rehabilitation program. Patient commitment and involvement are
essential for a good functional result. The specific exercises and
program timelines vary depending on the graft source used, and whether
surgical repair to other injured structures was performed.
The first phase of rehabilitation emphasizes range of motion,
which is critical to avoid knee stiffness.
A continuous passive motion
(CPM) machine is used in the recovery room and the first night.
This machine gently and steadily bends and straightens the patient's
Crutches are used for the
first 7 -10 days after surgery for comfort. Full weight bearing
would be painful.
Riding a stationary bike without
resistance and pool exercises to increase motion usually
begin about 2 weeks after the surgery.
Driving is allowed when
the patient is comfortable and has mobility, often as early as
2 weeks after the operation.
The patient returns for an office
visit about 2 weeks after the surgery so the incision and range
of motion can be checked.
The second phase of rehabilitation incorporates strengthening
and usually begins about 6 weeks after surgery.
A sports cord (an elastic
resistance strengthening tool) and the treadmill
are initially used.
Use of a stair-stepper or elliptical
trainer is added at about 8 weeks.
Strengthening using weights
is allowed at 2 - 3 months.
The third phase of rehabilitation
adds sport-specific exercises.
This phase is usually customized for the
patient's sports and activity level.
The final phase of rehabilitation
involves a supervised return to sports. This usually occurs approximately
6 months after reconstructive surgery.
knee braces used after ACL reconstruction?
Bracing after an ACL reconstruction depends on the surgeon's preference.
Some surgeons use no bracing while some use braces only during the
rehabilitation phase. Still others recommend that patients always
use a brace.
A post-operative brace is often used immediately after surgery.
This is a large, sturdy brace that limits motion and helps protect
the repair from an unexpected fall or twist. This type of brace is
easily adjusted to accommodate the changes in the knee as swelling
A functional brace is lighter and less bulky and is often used
during later stages of rehabilitation to protect the ACL reconstruction.
Some surgeons recommend continued use of a custom-fit functional brace
as a "safety-belt" during sports after this type of surgery.
What type of follow-up is done after an ACL reconstruction?
Usually, about a year following surgery, the doctor will evaluate
the knee to measure the final results of the reconstruction in these
such as pain or swelling
well the knee functions in daily living
or not the patient has been able to return to sports
Some of these follow-up exams have
shown that 90 to 95% of patients with ACL reconstructions have good
to excellent results.
What types of complications can occur with an ACL reconstruction?
Stiffness in the joint, or lack of extension, is the most
common complaint. This is why it is important to wait for motion
to return and swelling to go down before surgery, and
to follow the rehabilitation instructions given by the doctor and
Failure of the graft, reinjury to the ACL, or injury to other structures
in the knee are possible, and can cause recurrent instability. Blood
clots and infection in the joint are very rare occurrences.
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