Dr. Rakesh Kumar is one of the Best ACL Repair surgeons in Faridabad (Delhi NCR).
General Considerations
Progression ought to be based on careful monitoring by the Physical Therapist of the patient’s useful status.
Early emphasis on achieving full extension equal to the opposite side (including hyperextension within normal range, 10*).
Avoid direct palpation and mobilization on incisions/portals for 5 weeks.
No cutting or twisting until then cleared by Sports Test I.
No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
Patients should be well conscious that healing and tissue maturation continue to take place for 1 year after surgery.
Patients are given Sports Test I at 3 months, Sports Test II at 6 months, and Sports Test III at 1 year.
Weeks 1 – 2
Nurse apt on day 2 for dressing change and review of the home-based program.
Ice/elevation every 2 hours for 15 minutes to minimize edema and increase healing (please refer to the Icing handout).
Manual
Bland tissue treatment to quads, popliteal fossa, suprapatellar pouch, iliotibial band, and Hoffa’s fat pad. Extensive patellar mobilization.
No direct scar mobilization x 5 weeks.
Exercises
The seated edge of the bed dangles for knee flexion; prop for knee extension.
Gait training progression towards minimizing Assistive Devices (walker, crutches, etc).
Upper body conditioning, well-leg stationary cycling, or Upper Body Ergometer.
Quad sets/straight leg raises, hip abduction, calf presses, glut sets, and core exercises.
Goals
Range of motion: 0-90 degrees.
Gait weight-bearing as tolerated.
Pain < 3/10. Minimal Edema.
Good quality gait with the least amount of Assistive Devices.
Weeks 2 – 4
Suture removal on days 12-15.
Walking for exercise for 20-25 minutes if no limp or swelling is present.
Manual
No direct scar mobilization x 4 weeks.
Extensive patellar mobilization.
Exercises
Range of motion and functional strengthening exercises:
Squats/Leg Press, Bridges/Hamstring Curls.
2” step up/down, acute core training.
Goals
Active range of motion equals extension to the uninvolved side and flexion to 120 degrees. No edema. Full weight-bearing; general gait without assistive device. Single leg balance for 60 seconds on a level surface.
Weeks 4 – 6
Walk up to 1 hour for work out.
Exercises
Emphasize self-stretching to both lower extremities.
Increase the intensity of resistance activities (i.e. standing resisted squats, lunges, etc.).
Increase single-leg potency, and challenge proprioceptive training.
Goals
A Full Range Of Motion is equivalent to the uninvolved leg.
Perform a 4-inch step-down.
Bike with minimal resistance for 20-30 minutes (in the saddle), Elliptical, walking for 30 minutes, water-walking.
Weeks 6 – 10
Manual
Soft tissue mobilization and joint mobilization as required.
Exercises
Add lateral training Works out (lateral step-ups, step-over lunges).
Initiate tri-planar activities with the exception of closed-chain rotation (pivots).
No pivoting or cutting.
Goals
Activities should be pain-free.
Able to dismount stairs, double leg squat hold for >1 minute.
Bike >30 minutes with medium resistance, Elliptical with interval training, Flutter-style for swimming (no flippers, no breast-stroke kick).
Weeks 10 – 16
MD visit at 3 months
Complete game Test I and return to the pre-running program at 3 months (see handout for specific details)
Continue to increase strength and endurance, and add sport-specific training drills.
Goals
Pass Sports Test I.
Weeks 16+
MD visit at 6 months.
Sport test 2 at 5 months. Begin returning to run the program.
Implementation of jump training, and activity training. Education of “at-risk sports”.
After 6 months add lateral plyometric-type drills and an agility ladder.
Goals
Start sagittal plane plyometric, and work towards single leg plyometric. Clearance by MD and pass Sports metric training before returning to full athletics.
NOTE: All progress is an approximation and should be used as a guideline only. The development will be based on individual patient presentation, which is assessed throughout the treatment method.
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