The graft knee does not swell after surgery so quadriceps strengthening exercises can begin on the day of surgery. Strengthening exercises help the tendon to rebuild and fill-in the area that was used for the graft.
Note: If the graft is taken from the same knee, strengthening exercises are started after full range of motion is regained and swelling goes away.
We monitor strength by performing a series of strength tests at regular intervals. The ultimate goal is to restore symmetric range of motion and strength that is equal to or better than the pre-operative values.
Before Surgery
Time frames and exercises, described below, are general guidelines and will be tailored to meet individual progress.
Returning the knee to a normal state (except for the ACL tear) will speed up recovery time and allow goals to be more easily achieved.
Before scheduling surgery, the following conditions must be met:
Following surgery, a Cryo-Cuff® should stay on the ACL reconstructed knee at all times to prevent swelling (except during extension and flexion exercises).
The ACL reconstructed leg will be placed in a continuous passive motion (CPM) machine, which is used to elevate the knee above the heart to reduce swelling.
Motion Exercises for ACL-reconstructed knee:
Extension (straightening)
Heel props (perform quad sets at the same time)
prop up opposite leg to make sure extension is equal
Towel stretches for full hyperextension (equal to graft leg)
It is absolutely essential that the ACL-reconstructed leg is able to extend, equal to the opposite leg.
Flexion (bending)
Use the CPM machine to help with flexion.
Pull ankle toward the buttocks (using hands) as far as possible.
Measure flexion by using yardstick (centimeters).
Motion Exercises for Graft-donor knee
Extension
Graft-donor knee extension will not be affected and will be normal immediately upon doing first extension exercise.
Flexion
Heel slides
Measure flexion using yardstick (centimeter)
Strengthening Exercises for Graft-Donor Knee
Use the shuttle
Exercises for the ACL-reconstructed and Graft-donor legs may vary depending upon the ease of reaching and maintaining desired motion. Reaching full flexion and extension will speed up recovery.
Keep the ACL-reconstructed leg in the CPM machine at all times (except when doing exercises)
Remain in bed with ACL-reconstructed leg elevated above heart
When walking (to bathroom only), put as much weight on the ACL-reconstructed leg as tolerated
Putting weight on the ACL-reconstructed leg will not affect the reconstruction; however, being up with the knee below the level of the heart may cause swelling and problems with recovery
The patient must have the following to be released from the hospital:
Full extension of the ACL-reconstructed leg equal to the graft-donor leg
Flexion of at least 120 degrees on the ACL-reconstructed leg and full flexion on the graft-donor leg.
Ability to lift both legs with leg muscles
Ability to walk without assistance
Understanding of the home instructions for the next week
Most patients are able to gradually resume their normal daily activity our of bed during this week. Activity level will be determined by the condition of knees (activity increases as knee progresses).
Regaining patellar tendon strength is the main focus of rehabilitation between weeks two to four. Ideally, the patient should perform high repetitions of strengthening exercises several times a day.
leg press
knee extension (replaces shuttle)
The patients therapist or athletic trainer will design an individual rehabilitation program according to the patient's objectives and goals.
Physical therapy will continue to monitor rehabilitation as the patient returns to their preoperative, fully competitive level of activity. Strength, range of motion, and swelling will be evaluated at each vistit. Rehabilitation and sporting activities will be advanced as strength, comfort, and confidence allows.
Follow-up visits are typically every 1-3 months depending on your progress.
Follow-up visits (at no charge) at one, two, five, ten, fifteen, etc., years are requested for research purposes and are essential for the ongoing study of ACL- reconstruction.
