A knee reconstruction is a common term for the reconstruction of the ACL or anterior cruciate ligament of the knee. Rupture of the ACL is common and keeps a lot of our favourite sporting stars on the sideline for up to 12 months.
The ACL has a crucial role in stablilising the knee particularly with rotation and changing direction.
Unfortunately, ACL ruptures occur in non professional sports and even everyday life with activities involving twisting or turning. Females are more prone to ACL rupture from non-contact sports and males contact sports.
Surgery normally involves replacing the torn ACL with a graft made up of your own hamstring tendons or 1/3 of the patella tendon. The rehabilitation post operatively is crucial to the long term outcome of the surgery.
A recent study has shown that there is a 16.5% risk of re-rupture of a reconstructed ACL if the rehabilitation is not followed through to the end. Ouch!
Rehabilitation can be divided into 5 phases
1. Recover from surgery
2. Strength and neuromuscular control
3. Running, agility and landings
4. Return to sport
5. Prevention of reinjury
The aim of this stage is to:
1. Gain full extension
2. Reduce swelling
3. Activation of hamstrings and quads
4. Engage good co-contraction of these muscles together
5. Gently increase range of movement
After surgery patients are required to use crutches to mobilise with limited weight bear on the operated leg. Typically a brace will be fitted while walking.
The surgery itself is traumatic to the knee and a rest and recovery period is necessary. Typical exercises and management strategies during this phase include regular icing of the knee, compression of the knee and lower limb (We recommend the Ice Wrap Pro – see more here), simple quadriceps activation drills and gentle range of motion exercises to improve knee extension (straightening) and flexion (bending).
1. Regain most single leg balance
2. Regain muscle strength
3. Be able to single leg squat with good technique and alignment
In this phase it is important to re-build foundational strength of the knee. While strength is essential it is vital that balance and basic co-ordination are recovered. Weight bearing and body weight exercises will begin in this phase and progressed onto a gym based regime. If any pain and/or swelling is noted it is important to slow down as it is a sign that the knee isn’t tolerating the workload. Non-impact aerobic exercise can be included in this phase, e.g. cycling, swimming and walking.
In this phase the gym program continues to progress and also introduces a return to running, agility drills, jumping and hopping. By this time the knee should be free of swelling and pain during this phase. It is essential correct landing; jumping and pivoting technique is learnt and applied before returning back to sport.
The aim of this phase is to:
1. Regain full strength and balance
2. Have excellent jumping and landing biomechanics
3. Progress successfully through an agility program
Typical exercises in this phase include shuttle runs ladder and change of direction drills. Jumping and hopping exercises usually start with jump squats and single hops and progressed onto box squats eventuating into single leg landing with perturbations.
A recent study has shown there is a 50% reduction in risk of knee re-injuries (in all injuries not only ACL) for each month that return to sport is delayed beyond 6 months. This phase is highly individualised depending on the sport being played. The focus is not only getting the knee ready for return but the whole person. The knee must be stable and strong, with optimal neuromuscular patterning and biomechanics.
1. Progress training from restricted to unrestricted
2. Ensure the athlete is comfortable, confident and eager to return to sport
3. Continue an ACL prevention program while participating in the sport
The aim of this phase is to train safer neuromuscular patterns during standing, cutting and landing tasks. The key components of program include:
1. Plyometric, balance and strengthening exercises
2. Program must be performed more than once per week
3. Program continues for at least 6 weeks
1. Clin J Sport Med. 2016 Nov;26(6):518-523.
Agel J1, Rockwood T, Klossner D.
2. Br J Sports Med 2016;50: 946–951.
Kyritsis P, Bahr R, Landreau P, et al.
All Care Physiotherapy