Anterior Cruciate Ligament Tears and Their Treatment: arthroscopic and minimally-invasive surgery for ACL reconstruction
Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, October 20, 2006
RehabilitationPhysical therapy Postoperative physical therapy for a reconstructed ACL is
the standard of care. The primary
objective is to provide a safe environment where the patient can return to
normal function without compromising the integrity of the ACL repair.
Rehabilitation will proceed through controlled phases involving a close
working relationship between the physical therapist or certified athletic
trainer and patient.
- 0 - 2 Weeks - For the first two weeks after surgery, therapy involves at home
exercises that gently increase knee range of motion, control inflammation and
pain, and achieve thigh muscle control.
During this time, the patient will be allowed to weight bear on the
operative leg with or without the assistance of crutches. It is imperative that the individual remains
in the knee brace while walking.
- 2 - 6 Weeks - During this time, physical therapy will focus on preventing muscle
atrophy (shrinking), maintaining and increasing range of motion, progressing to
full weight bearing without crutches (while wearing the knee brace), and
improving muscle control. It is usually
possible to begin the use of an exercise bicycle during this time.
- 6 - 12 Weeks - In this stage of rehabilitation, the
physical therapist or certified athletic trainer will provide exercises that
increase muscle strength, stability, and endurance. Additionally, the patient will be working on
balance and performing exercises on an elliptical machine.
- 12 - 24 Weeks - At this point in time the patient will be
progressing to functional activities.
Individuals can expect to be running around 15- to 18- weeks, and
performing agility and cutting movements after 24 weeks.
Rehabilitation options The results of physical therapy are optimized by a competent
therapist familiar with ACL reconstructions and the usual
expectations. In addition, a compliant
patient who responsibly completes home exercises and is motivated to
improve will enhance the recovery period.
Most surgeons have a standard “protocol” that they give to physical
therapist or certified athletic trainer to let them know how to rehabilitate
the knee after an ACL reconstruction. It
is important for a patient to find a therapist with flexible hours and in a
convenient location because therapy will become a routine for several
months. The surgeon can recommend a
therapist with whom he or she is used to working and who is familiar with the
procedure. Therapy is generally done on
an outpatient basis, with 1 to 2 visits per week so that the therapist can
check the progress, review, or modify the program as needed to suit the
individual.Usual response Initially, there will be pain and swelling, but as this
diminishes patients are almost always satisfied with the range of motion,
comfort, and function that they achieve as the rehabilitation program
progresses. Typically, in the later stages
of rehabilitation, the patient feels comfortable enough that they want to
progress faster, but a delicate balance must be found between how well the
patient feels and a progression that does not disrupt the healing.
If the exercises remain or become painful, difficult,
or uncomfortable, the patient should contact the physical therapist and surgeon
promptly.Risks The greatest risks of rehabilitation entail the physical
therapist or certified athletic trainer being too progressive, aggressive, or
hesitant in achieving certain goals.
This can result in failure of the procedure (re-injury to the ACL
leading to knee instability), excessive knee stiffness, pain, or injury to
associated structures in the knee. These
problems are exceedingly uncommon and best prevented by communication between
the therapist and surgeon concerning the short and long term expectations
following this procedure.Duration of rehabilitation Every patient is slightly different in his or her
progression through the rehabilitation, but it can be expected that the patient
will be participating in rehabilitation for up to six months. Once the range of motion is acceptable and
the strength has returned, the exercise program can focus on functional
exercises that are applicable to the everyday life of the patient whether they
are a cutting athlete, runner, or heavy laborer. This may require sport-specific or
job-specific training with a physical therapist or certified athletic trainer.Returning to ordinary daily activities In general, patients are able to perform gentle activities
of daily living starting 2 or 3 weeks after surgery. Most persons who work at a desk job can
return to work during this time. The
patient is strongly encouraged to continue wearing the functional knee
brace.
The patient should be able to drive a vehicle when they
are no longer taking pain medications, and when they can perform the necessary
functions required for driving comfortably and confidently. A good question to answer prior to resuming
driving is: “Would you want you driving if your 4-year old child was in the car
or playing in the street?” If the answer
to this is “no”, then it is strongly encouraged to refrain from driving at that
point in time. In general it may take
longer for a person to drive if the right knee was operated on because of the
increased demands of pushing the gas and break pedal. Long-term patient limitations After completing a comprehensive rehabilitation program,
that allowed the patient to regain full range of motion and strength, patients
can return to physically demanding work and athletics without disability.
Depending on whether there were concomitant injuries, many patients will return
to cutting athletics at or above the level achieved before the ACL was torn.Costs The physical therapist should provide information of the
usual cost of the rehabilitation program.
Most insurance companies will cover the costs of some or most of the
rehabilitation, except perhaps a “copay” that the patient must pay at each
visit. Careful adherence to the home
exercises between visits will usually decrease the overall number and frequency
of visits required.Surgery for Anterior cruciate ligament - ACL - tear at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 or 425-646-7777 to make an appointment.
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