Patient Information Leaflet : ACL Reconstruction

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Because of the physiology of healing, the graft loses around 50% of its strength by the 5th to 6th week post-operatively. It is critical that the rehabilitation programme takes this into account and therefore ACL sheer forces which are particularly severe during the last 30º of extension, particularly when resisted, need to be avoided until the three month post-op stage. Following the above points, the following is the recommended rehabilitation programme for bone-patella-bone reconstruction.

SUMMARY : Rehabilitation Programme

PRE-OP
Physio assessment and outline the programme with the patient.

POST-OP
0 - 72 hours
1. Wool and crepe bandaging with drain in situ for 24 hours
2. Check xray
3. Mobilise.

Mobilise in brace, weight-bearing to comfort
Brace unlocked
Active flexion and extension, out of brace on the bed
Straight leg raises and resisted static hamstrings.
Goals : 1. 0-90º flexion
2. Straight leg raise
3. Home when safe and comfortable.

Weeks 1 - 2
Walking as normally as possible, wearing brace at all times, apart from washing and exercising.
Dispense with crutches as comfort allows.
Goals :1. Range of movement - 0-120°
2. Patella mobility - 75%
3. Swelling - minimal/none
4. Gait - normal

Weeks 2 - 6
Return to work if sedentary/supervisory

6 weeks - 3 months
Full weight-bearing in brace outdoors only (at work as required)
Out of brace indoors and for sedentary work
Resisted static dynamic hamstrings
Resisted static quads in the 90° - 45° range
Exercise bike and swimming as tolerated.

3 - 6 months
Brace for new exercises only or for confidence
Trampoline work, jogging in straight lines
Resisted static dynamic quads and hamstrings
Step ups onto bench/Stairmaster
Fast walking, building up to jogging figure of 8’s
Closed chain flexion/extension exercises.

6 - 9 months
Tighter figure of 8’s increasing speed gradually
Return to non contact sports such as squash, tennis, cricket (batting only)
One legged hopping.