STAGE I: 0-2 WEEKS

GOALS:

• Proper healing of surgical incisions.
• Edema control.
• Quad sets/ALR all planes without resistance, emphasizing SLR without extensor lag.
• ROM 0-90
• Normalized gait with assistive device, WBAT.
• Motion control brace 0-90.
• Patient demonstrates understanding of home exercise program.

RESTRICTIONS:

• Avoid terminal knee extension (0-30) in open chain.
• Brace to be worn during all weight bearing activities and exercises.

INTERVENTIONS:

• Check possible blood clot in calf.
• Monitor healing of surgical incisions.
• Instruct in home exercise program.
• Discuss goals of treatment with patient.
• Passive and active assisted extension
  a. prone knee hangs
  b. pillow under heel
  c. supine or seated hamstring stretch
• Passive and active assisted flexion
  a. heel sides
  b. supine wall slides
  c. sitting assisted knee flexion
  d. quadriceps stretch in prone or side lying
• Neuromuscular Re-Education: biofeedback to VMO 5/10 work/rest ration
  a. quad sets
  b. seat SAQ 90-30
  c. SLR
• Patellar mobilizations
• Strengthening
  a. leg lifts in hip abduction, adduction, and extension
  b. prone/standing hamstring curls
  *if patient has had a hamstring graft, call surgeon to determine when active contraction can be initiated.
  c. ankle pumps
• Gait training as needed
• Cold pack with electrical stimulation following exercises for edema control.

STAGE II: 2-6 WEEKS

GOALS:

• Edema control
• ROM 0-125
• Palpable and visible quadriceps contraction with patellar movement.
• Gait: FWB without assistive device, no limp, full knee extension in stance.
• Brace: open to all full ROM; custom brace when edema diminishes.
• Develop increased proprioception starting with stationary postures and progressing to dynamic movements.

RESTRICTIONS:

• Avoid terminal knee extension (0-30) in open chain.
• Brace to be worn during all weight bearing activities and exercises.

INTERVENTIONS:
Continue to progress the above exercises and add the following:

• Progress weights with SLR program.
• Begin low resistance bike when 110 degrees of flexion achieved.
• Proprioception: BAPS (single leg sitting progressing to standing), weight-shifting s/s & f/b, mini squats, heel raises, single leg balance, step over with cones.
• Strengthening: double leg press with light weight/high reps, step up f/b& s/s, T-Band hip exercises in 4 directions, side stepping over cones, wall squats (standing) or mini squats, bridging
• Friction massage to scar

LATE STAGE II: 4-6 WEEKS

INTERVENTIONS:

• Single leg press, single leg bridge, single leg heel raises, stool scoots
• Progress proprioceptive activities to dynamic surface
• Treadmill s/s & f/b with emphasis on normal gait
• Stairmaster f/b
• Eliptical
• Swimming/aquatic activities

STAGE III: 6 WEEKS – 3 MONTHS

GOALS:

• Develop eccentric neuromuscular control to allow acceptance of impact activities without increasing symptoms.
• Full ROM
• Resolve edema
• Develop dynamic flexibility to allow proper alignment during activities of increasing speed.

RESTRICTIONS:

• Avoid terminal knee extension (0-30) in open chain.
• Brace to be worn during all weight bearing activities and exercises.

INTERVENTION:

• Weight room activities: hip abd/adduction, hamstring curls
• Eccentric neuromuscular control: squat and reach, step downs, forward lunges, side stepping lunges, skipping, bounce jumps, jump stops.
• Sport Cord Ex’s: walking f/b, lunges f/b & s/s
• Proprioception: Single leg balance with ball toss
• (10 weeks): Sliding board for lateral agility

STAGE IV: 3-4 MONTHS

GOALS:

• Strength: 3 months – 60% ratio (involved to uninvolved)
• Strength: 4 months – 70% ratio (involved to uninvolved)
• Isokinetic quad work to full extension by 4 months.
• Develop adequate neuromuscular control with start/stop and change of direction movements.
• Initiate sport or activity specific training.
• Progress from double leg impact control to single leg impact control.

RESTRICTIONS:

• Wear functional brace for sport specific training, agility drills, and impact activities.

INTERVENTION:

• Dynamic flexibility: high knee walking, skipping, side shuffles, agility ladder, cutting, and pivoting drills.
• F/B jumping and hopping progressing to single leg balance/hop, trampoline jogging, lunge clock, jog and lunge, jump rotations, retro step up, initiate running when cleared with MD.

STAGE V: 4-6 MONTHS

GOALS:

• Strength: 85% ratio (involved to uninvolved)
• Return to function ADL’s and sport by 6 months

RESTRICTIONS:

• Wear functional brace for sporting activity up to 1 year.

INTERVENTION:
Progress jogging, plyometric, agility training, and sport specific drills.

ACL ARTHROSCOPY/RECONSTRUCTION INSTRUCTIONS

Knee arthroscopy represents a major advancement in the surgical treatment of knee problems. Arthroscopy can be done as an outpatient procedure as there is little health risk and discomfort is usually of short duration. Keep in mind that each patient’s recovery may differ due to specific type of surgery done and the individual’s unique healing response. The following information will assist you as you undergo arthroscopic surgery to repair your ACL.

PAIN
Initially, your knee will feel numb and therefore you will have little pain until the local anesthetic wears off. It is common for the knee to ache or throb the first couple of nights or after increased activity. Use ICE as instructed and pain medication as prescribed.

SWELLING
The knee may appear swollen and/or bruised after surgery. This is a normal result of both the procedure and the fluid used to do the surgery.

ICE
Use ice or ice compression the first 2 days after surgery for comfort and to reduce swelling. You should continue to use ICE as needed throughout the entire rehabilitation process until the swelling has resolved.

CRUTCHES
Crutches will be issued to you for use on day 1 following surgery and as long as they are needed. Discontinue use of crutches with you can walk comfortably with a minimal limp unless you have been instructed to use them longer.

WOUND CARE
Generally, all incisions sites are closed with disposable stitches. Meaning, that you will not have to have them removed by your MD. Immediately following your surgery, you will be placed in an ACE wrap. Steri strips will be placed over all your incision sites. At your 1st post-op visit to the MD, he will inspect your sites and remove all bandages. Clean steri strips will be placed on the incisions sites and you should leave them in place until they start to fall off. It is ok to take a short shower and get the steri strips moist. DO NOT immerse your knee into a bathtub or pool until your incision sites are completely closed.

MEDICATION
You will be given one or two prescriptions for medication following surgery. Use the pain medication as needed. Take the ENTIRE course of antibiotics as directed.

ACTIVTY
Slowly increase your activity level as tolerated. If there is significant swelling or discomfort following increase activity, you are probably “doing too much, too fast.” It is not wise to drive until you have control over your leg and you can bend the knee enough to control the pedals. Remember to use your best judgment and be reasonable as you resume your regular activity.

BRACE
You will be issued a post-op brace in the operating room. This brace is to be worn at all times when up and walking around. Typcially, you will wear the brace 2-4 weeks until a custom, functional brace is ordered and issued to you.

CPM
A continuous passive motion (CPM) machine will be issued to you prior to surgery. An AOKC staff member will instruct you in how to use the machine.