Physiotherapy Protocol for Patients Undergoing: Anterior Cruciate Ligament (ACL) Reconstruction
Post-operative intervention
Goals of treatment:
1. Decreasing the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE)
2. Strenghtening of muscles
3. Maintaining range of motion (ROM) of joints
4. Early mobilization and gait training
5. Balance and proprioceptive training
6. Education of patient regarding special precautions and rehabilitation period
7. Maximizing functional status regarding AOD
8. Eventual return to social/competitive activity level
Physiotherapist will treat the patient 2X daily
WEEK 1
Post-Operative Day 1
Brace: immobilize knee in full extension immediately post-operatively
Electrical muscle stimulation: for quadriceps to prevent muscle atrophy – 20 minutes/day
Cryotherapy: Ice packs – 20 minutes every hour, or Cryocuff continuously
Elevation: pillow under ankle (No pillow under knee)
Exercises:
Ankle pumps (Plantar/Dorsi-flexion)
Passive ROM (0-90º) may use CPM machine (surgeon’s decision)
Straight leg raises (SLR) in all directions: 10 reps x 1 set
Stretching (hamstring, calf muscles): 5 reps x 10 secs hold
Quadriceps isometric exercise: 10 reps x 12 sets
Partial weight-bearing (< 50 %) using 2 Axillary crutches as tolerated
Exercises should be done 2-hourly, pain permitting.
Transfers to and from the bed, chair and toilet will be taught. The patient should mobilize around the room and should sit in a chair for part of the afternoon. Balance, strength, endurance, blood pressure and dizziness will be monitored and documented.
Post-Operative Day 2-4:
Brace: Keep the knee in the brace and in full extension
Muscle Stimulation: Electrical stimulation for quadriceps: 20 minutes/day
Cryotherapy: Same as day 1
Elevation: Keep the knee elevated and in full extension.
ROM: Patient out of brace 4-5 times daily to perform ROM for him/herself
Weight-bearing: partial as tolerated (using two crutches)
Exercises:
Ankle pumps 20 reps x 2 sets
SLR in all directions: 20 reps x 2 sets
Continue stretching exercises
Patellar mobilization
Multi-angle isometrics: 90º, 60º, 30º – for quadriceps.
Continue ROM exercise as day 1
Closed kinetic chain (CKC) exercises: mini-squats: 10º-30º ROM only
Post-Operative Day 5 until discharge home:
Continue same program till patient discharge from the hospital, increasing intensity as tolerance and condition improves, following goals outlined for Week 2 (see below).
WEEK 2:
Brace: locked brace during ambulation only. Unlocked for ROM exercises performed by patient
Muscle Stimulation: Same as before
Cryotherapy: same as Week 1
Elevation: Keep knee elevated as before
Weight bearing: As tolerated. Goal: discontinue crutches 7-10 days post-op: surgeon’s opinion
ROM: Knee out of brace 4-5 times daily to perform ROM exercises by him/herself
Exercises:
Multi-angle isometric at 90º, 60º, 30º – for quadriceps
SLR in all directions 15 reps x 3 sets
Knee extension (active/assisted 90º-30º) 15 reps x 3 sets
Active quadriceps isometric (full extension) 15 rep x 3 sets
Patellar mobilization
Hamstring and calf stretching 5 reps x 30 second hold
Passive ROM (0-105º)
CKC: mini-squats (0-45º, and weight shift) 20 rep x 3 sets
Balance training: weight shift side-to-side, and forward/backward
Progressive resistance exercise (PRE) program: start with 1 lb as tolerated, and progress by 1 lb per week
Tags: Anterior, Cruciate, Ligament, patients, Physiotherapy, Protocol, reconstruction, Undergoing