Professional Documents
Culture Documents
(ACL) Tears
Anterior drawer
Lachman test
Serial Exams
Plain radiography
Arthrocentesis ?
MRI??
Treatment for ACL tears
There are both surgical and non-surgical options for treating an ACL
tears.
Surgical
* When doctors do ACL reconstructive surgery, they usually
replace the ligament by a substitute graft made of tendon.
This is because ACL tears that used suture to sew it back
together showed to fail over time. Some of the grafts that
doctors may use are Patellar, Hamstring, Quadriceps, Auto
graft (taken from a cadaver).
* In repair surgery, the doctors sews together the torn ligament.
This type of surgery has been shown to fail, therefore more
often the doctors will do reconstructive surgery.
Arthroscopic Surgery
There are many benefits to this surgery and it is
becoming more popular.
This surgery:
- Uses smaller incisions
- Has fewer risks than open surgery
- Rehabilitation is usually quicker
- Doctors can see and work on the knee structures
*The primary goal of ACL surgery is to restore
normal stability in the knee and the level of
function the person had before the knee injury,
limit loss of function in the knee, and prevent
injury or degeneration to other knee structures.
The picture above shows an arthroscopic view of an ACL after using a hamstring auto
graft.
Rehabilitation
Physical therapy is a crucial part
of ACL surgery. Most of the
success of the surgery is
dependent upon the athlete’s
determination to build strength
within the knee. This should begin
immediately after surgery.
The first 10-14 days after the
surgery, the focus is on the ability
to fully straighten the knee and
restore quadriceps control. The
knee should be iced regularly to
reduce swelling.
Physical therapy will work on the
same exercises as post surgery,
but an athlete may have to modify
their activity style. For example,
limit sports involving cutting,
pivoting and landing.
Sample Rehabilitation Program
WEEK 0-2:
Weight bearing as tolerated(25%-50%)
Quadriceps and Hamstring isometrics
Electrical muscle stimulation
Ankle ROM and strengthening
Heel slides
Patellar mobilization
WEEK 4:
Full weight bearing with protective brace Straight leg raises
Quadriceps and Hamstring isometrics
Straight leg raises
Electrical muscle stimulation
Pool exercises (hip and ankle)
Stationary bike
Trunk/ pelviis stabilization
WEEK 6:
Full weight bearing without brace
Quadriceps and Hamstring isometrics
Straight leg raises with weight
Hamstring curls
Hamstring Curl
Hip progressive resistance exercises
Proprioceptive training
Cycling for ROM
Contd…
WEEK 8:
Full weight bearing without brace 6 MONTHS:
ROM should be 0 and 110 degrees Flexibility exercises
Cycling Begin terminal knee extension
Hamstring curls Running drills
Jump rope Drills specific to sport or occupation
Swimming
3 MONTHS:
ROM 0 and 125 degrees
Treadmill walking
Cycling
Quarter squats
Plyometric drills ( bouncing, box jumps
etc)
4 - 6 MONTHS:
Full ROM
Agility drills
Isotonic knee extensions
Isokinetics when 10% of body weight
can be done isotonically
Step-ups
Bracing
“There is little evidence to
support the use of a post-
operative brace following
isolated reconstruction of the
ACL.”
“Although the exact
mechanism for any beneficial
effect of functional bracing
remains unknown, ACL
deficient athletes commonly
report improved confidence
with use of a functional knee
brace.”
“The use of functional bracing
should perhaps be reserved
for return to sport following
revision surgery or in athletes
who have suffered a multiple
ligament injury.”
Rehabilitation
Slight variations depending on age, history, activity level, graft
source and associated injuries.
Five phases
Phase I- Immediate post-op (0-2 weeks)
Phase II- Early Rehabilitation Activities (2-6 weeks)
Phase III- Advanced Rehabilitation Activities (6-10 weeks)
Phase IV- Advanced Functional Activities (10 weeks- 6
months)
Phase V- Return to Sport (6-12 months)
Returning to competition
The patient may return to sports when there is no more pain or
swelling, when full knee range of motion has been achieved, and
when muscle strength, endurance and full use of the leg have been
fully restored.
If patient has met criteria of full ROM, good stability, and 90% or
better strength compared to uninvolved extremity they are
considered to be eligible to return to play.
They should also have a positive psychological mind set.
The final decision should be made by the physical therapist who
has been through the entire rehabilitation process.
Prevention