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Recovering from an ACL Surgery

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Bryce Zicarelli

on 28 November 2016

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Transcript of Recovering from an ACL Surgery

Why surgery?
The purpose of pursuing surgery with an ACL tear is to restore normal range of motion and level of function and limiting pain and the likelihood of developing ostioperosis. It also might not always be neccessary to perform surgery. Surgery might not be optional if other knee structures are involved like the meniscus, fibula, MCL, etc.
After surgery the first thing to be concerned about is managing pain and swelling. If necessary crutches may be used to help stability and comfort.
- It is important to keep the knee in flexion as much as possible so the walking gate is not effected by scar tissue build up.
- Not only helps with pain but greatly reduces swelling. 20 minutes on and 20 minutes off is the best way to apply ice. Heat will increase swelling because it will open blood vessels to the area; increasing blood flow.
- Wrap a bandage around the area to create support and reduce swelling. It can be worn during rehab if comfortable. It is important not to wear the bandage at night because it can cause inefficient circulation to the lower half of the leg.
- Keeping the knee at 180 degrees elevated at or above heart level to reduce blood flow to the area. It is also important to not apply direct pressure to the back of the knee.

Rehab Phase 1: Weeks 1 & 2
Regain full ROM and be completely off crutches

Rehab Phase 4: 3-6 Months
By: Bryce Zicarelli
Recovering from an ACL Surgery
First few days after surgery...
It is important to focus on extension because scar tissue build up can make it difficult to straighten the knee in the long run. However, flexion (focusing on the back of knee), is easier to regain.
Exercises that help this phase include:
Quad Clenches
- It is important to strengthen the quad (while knee is flexed). To achieve this exercise prop the heel up while the leg is straight, you may lay down or sit up. Begin by pushing your knee downward toward the table, keep the muscles on the anterior of your knee flexed until you feel a stretch on the posterior of your knee. Hold for 10 seconds, repeat 10 times, repeat 2-3 times daily.
Heel Slides
- Like the quad clenches you may either sit up or lay day, it may be easier for some to sit up. Start with your leg flat, it should require too much strength to ben up knee and hip while keep your foot in contact with the table. Keep your leg bent for 3-5 seconds and straighten it out. Repeat 10-20 times, 3-4 times daily.
Wall Slides
- For this exercise lay flat on the ground with your legs up against a wall or door. This exercise is important to regain knee flexion so bend your knee in as much as possible while slidding your foot down the door/wall. Repeat 10-20 times, 3-4 times daily.
Rehab Phase 2: Weeks 2-6
Stabilization and strengthening targeted towards the quads, butt muscles, and hamstrings.
This phase is important for regaining awareness of your leg/knee and its positioining. This is called 'proprioception', meaning "one's own" in Latin, it is actually the process of bringing awareness back to the positioning of your leg/knee. Balancing exercises can be particularly beneficial for this stage because the ACL takes on a major roll in reflex control.
It is important to discuss with your doctor when returning to work/driving can be achieved but by the end of this stage that is a major goal including: having full ROM, being able to stand on the effected leg for about 20 seconds and have little to no swelling left.
Exercises that help this phase include:
Wall Squats
- Begin flat on the wall with your feet a few inches away from the wall and at hip width distance apart, toes facing outward. This exercise is for increasing quad strength so slowly start by bending at the knees and sliding down the wall until your knees are at about 45 degrees (you may also consult your doctor to see if you should be stopping higher or lower on the wall). Hold in a squat for 5 seconds and come up. Repeat 10-20, 2-3 times daily.
- Also brings in core building. Lay on your back with your knees bent and your feet fully on the floor or mat. Start by tightening your core and glute muscles in order to lift your body straight up so only your shoulder blades are on the floor/mat. It is important to remain straight and not arch your back. Hold for 10 seconds and then slowly lower. You can also at a progression (shown to the right) by lifting one leg while keeping your hips alligned and then repeat on the other side. Repeat 10-20 times, 2-3 times daily.
Once you are able to stand on one leg for about 30 seconds you can add actions to make it a little more challenging like having someone gently push you and remain balanced, throwing a ball against a wall or in the air and catching it, or even just closing your eyes.
It is also beneficial to stretch out your quads during this phase by touching your toes while keeping your knees straight.
Rehab Phase 3: Weeks 6-12
It is extremely important to avoid any pivoting or side-to-side motions like ice skating or basketball. However, during this stage you should be able to begin swimming (avoid breast stroke until around 4 months post op), stationary biking while building up the resistance and running. You cannot run at even half your normal pace so start with a light jog and avoid changing direction or surface. Sometimes a treadmill is recommended.
You can also add on progressions to most of the previous exercises to challenge yourself during this stage but your knee is most vulnerable at this stage so take it slow as to not aggravate your knee.
80% of ACL tears actually dont occur from contact. Most injuries come from twisting the leg, landing awkwardly on the leg, over extending the knee and even from decelerating too quickly.
There are 5 particularly common signs of an ACL tear:
A popping noise
- About 50% of cases report hearing an actualy popping or cracking noise at the moment of injury.
- It is caused by the damage done to the blood vessels in the knee. Sometimes there is little to no swelling at all. In smaller tears swelling can start a few days after but with a more severe tear it begins within 6 hours.
- Usually there is a large amount of pain especially while trying to bare weight on the leg or bend the knee.
- The knee is often now unable to hold weight or feels unstable.
Decreased ROM
- The ACL is vital for movement but particularly extension.
#1 Goal:
Return to play! This can be achieved by doing sports specific exercises and activities given to you by your physical therapist or athletic trainer.
It is important to regain full stability by performing extra prioprioceptive exercises. It is also to be hyper aware of twisting and pivoting because the knee is it not at 100%.
Rehab Phase 5: 6-9 Months
At this point of recovery none contact sports including full ROM will have been achieved.
Three other key points of this phase include:
1. Being able to run in a straight line at full pace.
2. Being able to run from side-to-side, front-to-back, and in a figure 8.
3. Hop and jump in all directions with no discomfort.
Phase 6: 9 Months +
Contact sports are now ready to be performed. It is vital to wait for this phase to do sports like lacrosse and soccer because it is to ensure full recovery
Simple Negative Implication of an ACL Rupture
Decreased Stability
- If there was a lack of rehabilitation/exercise it may be more difficult to return to sports. This may also be due to the ACL not healing tight enough.
Stiffness or Instability of the Knee
- As has been explained, extension, and regaining that vital action, is extremely important because if it isn't fully gained it may prove difficult to have a normal walking gate. A tip during the heeling process is to elevate the knee and make sure it is fully extended with nothing pushing against the back of the knee.
Re-rupturing the ACL
- Wearing a brace can greatly help prevent this but it isn't particularly common; occurring in about only 3% of cases.
Patella Pain
- This is common in 10-20% of patients mostly due to lack of rehab and exercise effort. Anterior knee pain while squatting or kneeling can almost 100% be avoided.
Complicated Negative Implication of an ACL Rupture
What is arthritis?
- The knee joint is made up of three bones: The fimur, the tibia, and the petalla. The end of each bone is covered by a thick layer of protective tissue that acts as a shock absorber and cusioning for the joints called, cartilage. Arthritis is the name given to the wear and tear of cartilage leading to its thinning which causes spurs. Arthritis also causes inflammation and stiffness in the bones which is known to be extremely uncomfortable.

It is known to be more common to develope arthritis after ACL rupture reconstructions.
Arthitis is more avoidable if regaining stability and strength is a top priority.
Complicated Negative Implications of an ACL Rupture Pt. 2
Patellar Tendonitis:
What is patellar tendonitis?
- Image what a pole jumper has to endure, the kind of strain on their knees, constantly jumping and landing. This causes, overtime, micro-tears in the tendon which will ultimately lead to inflammation and pain. The pain will get worse over time and last for longer periods of times. It will eventually result in a tear of the tendon needing surgical repair.
Again, it is important to follow the rehab timeline accordingly in order to avoid this.
This usually only develops is surgery is performed on the ACL. Inflammation results when the middle third of the tendon is removed and replaced with a new graft.
ACL injuries are very serious but can be avoided
Simple steps can be taken
Stretching and warming up before exercise
proper strengthening, agility, and sports specific exercises
Plyometric exercises are beneficial because they help the body get used to explosive power, speed and strength.
Simply taking the time to cool down.
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