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A Condensed Post-ACL Surgical Reconstruction Rehabilitation Guide

It is important to understand that every person goes through the ACL protocol at their own pace and allows the criteria to determine their progress, an ACL guide is not a pre-determined timeline.


1. RECOVERY FROM SURGERY

  • Get the knee straight (full extension) - by WEEK 4

  • Settle the swelling down to ‘mild’

  • Get the quadriceps fired again

  • Regular icing of the knee and graft donor site (usually hamstring or patellar tendon)

  • Compression of knee + lower limb

  • Basic quadriceps setting exercises + gentle range of motion exercises to improve knee extension & flexion

2. STRENGTH AND NEUROMUSCULAR CONTROL

  • Regain most muscle strength

  • Regain most of balance

  • Single-leg squat with good technique and alignment

  • Commence with easy bodyweight exercises, progress into resistance, balance, and coordination

  • *Important*: listen to the knee – increase in pain and/or swelling, 2 main symptoms knee is not tolerating workload

  • Lunges, step-ups, squats, bridging, calf raises, hip abduction strengthening, core exercises, balance, gait re-education drills, non-impact aerobic conditions (cycling, swimming, walking)

3. RUNNING, AGILITY & LANDING

  • Score ‘excellent’ on a jump-rebound task

  • Progress successfully through an agility program

  • Regain full strength & balance

  • Return of running, agility, jumping + hopping, the continuation of gym-based strength + neuromuscular program

  • Knee should be free of swelling + pain

  • Emphasize correct technique, especially deceleration tasks

  • Agility drills – slalom running, shuttle runs, ladder drills, etc.

  • Jumping exercises start with scissor jumps, single leg hops. Progress to box jumps + single leg landings w perturbation.

  • Important there’s one rest + recovery time

4. RETURN TO SPORT

  • Successful completion of Melbourne Return to Sports Score (95)

  • The athlete is comfortable, confident, and eager to return to sport

  • ACL injury prevention program is discussed, implemented, and continued whilst the athlete is participating in sport

  • Highly individualized, exercises + training activities would normally be integrated into their regime

  • Focus on getting the person ready for sport, not just the knee

  • Knee needs to be stable & strong, with optimal neuromuscular patterning and biomechanics.

  • The athlete needs to be confident and mentally ready to return

5. PREVENTION OF RE-INJURY

Successful ACL injury prevention programs include:

  • Plyometric, balance, and strengthening exercises

  • Program must be performed more than once per week

  • Program continues for at least 6 weeks

  • Most ACL injuries + re-injuries occur in non-contact situations with either cutting movement or one-legged landing

  • ACL injury prevention programs aim to train safer neuromuscular patterns during tasks

  • Females have a higher risk of ACL injury (x2-8) compared to males who undertake same sport or activity

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