Post-Operative Accelerated Anterior Cruciate Ligament Repair Rehabilitation Protocols (Weeks 1-4)

Heel Slides³

Russian E-Stim⁴

An Anterior Cruciate Ligament (ACL) rupture is one of the more common injuries for female sports that involve jumping. The ACL, once ruptured should be surgically repaired, if the athlete plans on being extremely active to increase stability^.1 Surgical repair involves using either a cadaver graft or a portion of the hamstring, which is held in place by anchors.² Immediately after surgery, the Post-operative (post-op) phase is one of the most important times of recovery. During the first two days of post-op, the athlete should work on decreasing swelling and pain with ice and regaining their extension capabilities, via passive knee extension exercises like prone hangs or gravity hangs.¹ The athlete should work on hip range of motion (ROM) such as straight leg rises. Quadriceps (quad) sets, which are controlled contractions of the quad while the knee is in extension and Russian electrical stimulation (e-stim) can be used to reeducate the quadriceps muscle group. Russian step should focus more on the vastus medialis oblique (VMO) muscle. The athlete should also work on patellar mobilizations within the first week of post-op. Soft tissue treatment should be done to assist in ROM and to release capsular tightness.² 

Patellar Mobs⁴

During the second week of post-op rehabilitation, the athlete should work on active ROM for the knee, such as heel slides.² Heel slides will improve the athlete's knee flexion. For weeks 3 and 4, the athlete should work on strengthening their quad and increasing their ROM.² The stationary bike can be used to conduct closed kinetic chain exercises during the following weeks.² At the end of the fourth week, the athlete should have knee flexion of 0-110°.² For the duration of post-op rehabilitation, some pain is expected, but swelling and increases in temperature should not occur.  This would indicate anti-inflammatory response. .²

¹Staerf, D. A., Pastides, P. S., Sarraf, K. M., & Willis-Owen, C. A. (2014). Anterior cruciate ligament reconstruction best practices: A review of graft choice. World Journal of Orthopedics, 5(1), 23-29.

²Houglum, P. (2010). Therapeutic exercise for musculoskeletal injuries. (3 ed., pp. 623-625). Greensboro: Human Kinetics.

³http://www.intlgymnast.com/index.php?option=com_content&view=article&id=2735:canadas-savona-takes-acl-rehab-step-by-step&catid=2:news&Itemid=53

⁴http://www.mikereinold.com/2013/03/rehabilitation-following-acl-reconstruction-surgery.html