Physiotherapy for ACL Reconstruction
Physiotherapy after anterior cruciate ligament (ACL) reconstruction is crucial to achieving a successful outcome. Though a structured program with distinct phases, patients ultimately strive to return to play or competition. Recent evidence suggests that a minimum of 9 months before allowing a full return to activity is ideal for minimizing re-injury and optimizing outcomes.
Principles of ACL Rehabilitation
The phases outlined below for ACL physiotherapy are for patients undergoing an autograft ACL reconstruction. Progression and specific exercises and milestone may change if concomitant procedures such as meniscus repair or cartilage repair are performed.
During the first six weeks, the priority is to decrease swelling, obtain full extension of the knee, and achieve full flexion. Patellar mobilization is important to minimize scar tissue formation and encourage pain free range of motion. Quadriceps stimulation and isometric exercises are necessary to prevent atrophy and to improve ambulation. Working on core strength with side-lying exercises is also encouraged.
Upon achieving full range of motion and minimizing knee swelling, more attention is devoted to quadriceps strengthening using closed chain kinetic exercises, balance exercises, hamstring curls, stationary bike, and advanced hip/core exercises.
After 12 weeks, progressive work on core muscles, advanced closed chain kinetic strengthening, proprioception training is encouraged. Elliptical use can commence at approximately 10 weeks and running straight ahead commences at 12 weeks.
After 4-5 months, patients can commence jumping, sprinting, backward running, cutting activity, and plyometric exercises that are sports specific
Sports Specific training commences at six months. Full return to competition is permitted at 9 months postoperatively. Generally agreed upon criteria to return to sports include full motion, absence of swelling, quadriceps strength >80% compared with the normal leg, and the absence of subjective pain and instability.
For more detail regarding ACL reconstruction surgery and ACL rehabilitation, please see the Therapia videos created by Dr. Jas Chahal and chief Therapist Adam Brown.