Instructions for after your ACL Reconstruction Surgery
The goals after ACL reconstruction surgery in the initial phase are to ensure:-
• Appropriate wound healing
• To keep swelling to a minimum
• Regain full extension or straightening
• To get back fully weightbearing and walking normally
• To wean off crutches
• To promote muscle control
It is very important to minimise swelling to ensure that movement is able to be restored. There are a number of options for managing swelling and this would include regular ice, compression bandages, anti-inflammatories. Patella mobilisation or regaining active knee range of motion is also very important for reducing swelling.
The post-operative rehabilitation protocol is orientated towards maximising the early range of motion and muscle control to ensure a rapid recovery.
The rehabilitation programme is divided up into different stages. Transitioning between stages would be supervised by your physiotherapist and you need clearance from your therapist to transition between the stages.
At the time of discharge it is appropriate for you to contact a physiotherapist to ensure that you can get in for an appointment as soon as practical.
At Discharge
You should be mobilising independently with your crutches and pain should be under control.
There is generally no stitches and most wounds are covered with sticky tapes and dressings. The dressings can come off 7 to 10 days after your surgery.
You may notice a small amount of numbness around the front of the shin or adjacent to the incisions. This is not uncommon and will usually settle.
What to Watch Out For
If you have concerns in the first few days after discharge, you can call Manuka Street Hospital on (03) 548 8566 for advice. Staff are on the ward 24 hours of the day.
Make contact if you experience the following:-
• Wound discharge or bleeding that doesn’t settle after elevation for 30min
• Increasing pain that is not controlled with elevation for 30min and the pain relief provided
If you develop calf pain, chest pain, shortness of breath then you need to either see your GP promptly or been seen in an emergency clinic/hospital.
Follow-up Appointment
You should be provided with an appointment time for follow-up around 2 to 3 weeks following your surgery.
If you have any concerns or need to alter your appointment please contact Mr Peterson’s rooms on (03) 539 0988. Your follow-up will be at the Collingwood Centre, level 1, 105 Collingwood St, Nelson
ACL REHABILITATION PROTOCOL
Phase 1 (weeks 0 to 2)
Movement: Work hard on regaining full straightening and bending of the knee. This will gradually come. Take pain relief as needed to facilitate this. Every 1-‐2 hours place a rolled up towel under the heal and practice contracting the quadricep muscles to help straighten the knee
Walking: Try to walk with a normal heal toe walking pattern with full weight through the operated leg.
Crutches: These can be discarded when you are walking normally with good balance and confidence.
RICE: The regular use of ice packs will help to limit swelling and discomfort. Don’t underestimate how effective this can be. It is often useful even as you progress within that first week or two after surgery. Limiting swelling will allow for earlier range of motion.
Exercycle: You can start an exercycle as soon as you are confident. This is usually in the 2nd week. Initially use no resistance and just get the knee bending with a high seat height. Aim to build up your duration to 30 to 40 minutes before considering resistance. Try and do this at least 3 to 4 times per week.
Phase 2 (weeks 2 to 12)
Physiotherapy: Your therapist is important for managing you through the early post-operative phase. Your first appointment is usually in the first week or two after surgery and they will help guide you from this point onwards. Generally this will be covered by ACC, but there can be a surcharge associated with this. This is something for you to discuss with your therapist.
Gym Programs: A gym program is very useful for regaining strength. You should look to undertake exercises that have your foot planted on something (closed chain exercises). This includes short squats, leg press, lunges, rowing machine etc. A trainer can help with choosing these exercises with you. You need to avoid exercises with your foot in the air such as hamstring curls and resisted knee extension for 2 months.
Exercycle: This is still a mainstay of your program. Gradually increase the resistance and duration. Aim to build up to 45 min 4 to 5 times per week. Try alternating between dropping the seat height to flex the knee more and lifting it to fully straighten the knee.
Balance Work: This may include standing on one leg and as you progress you may incorporate doing toe raises or short squats or closing your eyes etc. You can even practice standing on 1 leg whilst doing your teeth etc. Avoid a wobble board until later through.
Swimming: You can get into the pool when your wounds are dry and healed. Avoid kicking especially breaststroke kick until 8 to 10 weeks. A pool buoy can be used for fitness training.
Strengthening: At approximately six weeks under the guidance of your therapist you will be able to progress some hamstring and quadriceps strengthening work. They will be able to guide you through this, but this will involve some prone knee flexion exercises, bridging off a chair, and other exercises such as light squats, leg presses, single leg lunges, progressing towards running. This should all be done under the supervision of a physiotherapist. at no point in time should you be pushing into the pain zone and you are progressively working the leg with only subtle strain or tightness following exerecises.
Phase 3 (weeks 12 to 16)
During this phase you will be starting to progress into agility and plyometric work. Again it is important that this be done under the supervision of a therapist as they will be looking at your technique and alignment. You will be starting to work on running as well.
Running: You can now start light jogging in a straight line, initially short distances then building up. You must avoid pivot, change of direction or speed work at this stage.
Hopping/Landing: Practice doing some hopping and landing drills. Start with both legs together until you gain your confidence. Start small and gradually increase distance but don't push it. You are better going for repetition than distance. Once you are confident then try jumping backwards and up small stairs.
Gym: Continue with your gym program throughout this stage.
Phase 4 (4 to 9 months)
Review the Fifa 11+ return to sport program on line. This gives you a return to sport program designed to reduce the risk of another ACL injury. http://www.f-marc.com/11plus/manual/
Gradually start sport specific retraining such as ball kicking, passing, shooting etc. Use common sense though, don't try any sudden change of direction.
Light training can be started from 6 months.
Return to contact or sudden change of direction sports are generally at 9 months but this is patient specific based off your progress through the programme. This includes sports such as rugby, netball, football, hockey, tennis etc.
You must be full training for at least a month before resuming competition sport.