An ACL rupture is a tear in a ligament that is vital to knee stability. It occurs most commonly in young and active people and can have negative long-term impacts. The diagnosis is made using a combination of the patient’s history, clinical findings and imaging studies. the goal of treatment is restoration of knee function, preventing further injury and osteoarthritis, and restoring preinjury levels of function and the ability to participate in activities of choice.
Post-operative physical therapy is always required, however you may also require therapy prior to the ACL reconstruction. This decision is based on your range of motion and the specifics of your exam with Dr. Cooper. Note: Dr. Cooper refers to and works with physical therapists who follow evidence – based guidelines and recommendations to assure that you receive high-quality rehabilitation.
Patients who have an ACL tear and damage to the meniscus or other knee ligaments may be advised that surgery is their best option to achieve pre-injury function; and may choose reconstruction and post-operative rehabilitation.
Some patients may desire to weigh their options with Dr. Cooper. He will sit with you and discuss the pros and cons of the various options; as well as your expectations about returning to your sport(s) of choice and achieving pre-injury activity levels. Dr. Cooper will review with you the recovery programs and answer your questions.
Recovery without surgery
Nonsurgical treatment involves rehabilitation to restore function including range of motion, balance and strengthen exercises. If you are less active and don’t anticipate participating in running, jumping and pivoting activities you may choose to avoid surgery. You will still need physical therapy to restore strength and range of motion in the injured knee. Nonsurgical recovery with rehabilitation takes two to three months.
Recovery with surgery
If surgery is recommended, you will, when possible, begin pre-operative rehabilitation before surgery to strengthen the quadriceps and hamstrings. Studies show that pre-operative rehabilitation decreases the risk of developing excess scar tissue in the knee and improves post-surgical outcomes when compared to those who had no or limited pre-operative rehabilitation before surgery.
Pre-operative rehabilitation steps
When the ACL is injured the major muscles that surround and stabilize the knee, the quadriceps and hamstrings, weaken. Fluid from swelling makes it difficult to straighten the knee.
After injury, whether or not surgery is planned, high-quality pre-operative rehabilitation involves regaining range of motion, strengthening the quads and hamstrings, proprioception (awareness of the position and movement of the body including balance) and stability.
- The knee will be immobilized, and you will use crutches until sufficient muscle control has been restored.
- Cryotherapy to control swelling and pain.
- Physical therapy to restore range of motion and muscle strength.
- Neuromuscular training to improve stability.
- High- intensity electrical neuromuscular stimulation is effective to improve quadriceps strength.
Post-Operative Rehabilitation Timeline
Goals: Protect the new ligament graft, restore quadriceps function and leg control, and return the patient to normal function without compromising the reconstruction.
- Exercises begin immediately in the recovery room.
- Crutches for comfort. Increased weight bearing as tolerated. Most patients can stop using crutches by two weeks after surgery unless they also received surgical repairs of the meniscus or other knee ligaments.
- The first three weeks the goal is to increase range of motion while the new ligament heals. Regular icing and elevation to reduce swelling. Exercises focus on restoring 90º range of motion and achieving quadriceps control.
- Weeks 4-6 focus on strength training, light weights, full range of motion. Improve endurance and proprioception. Protect the new ligament. Some cardio. Begin weight bearing exercises.
- 6-12 weeks. Strengthening quads and exercises for power, proprioception and coordination. Prepare for return to sport. Jogging may be allowed at 3 months. Should have full range of motion and begin using a stationary bike or stair climber to maintain range of motion and strengthening the quads and hamstrings.
- 4-6 months. Goal is safe return to sports. Focus on maintaining strength, endurance and proprioception. If needed, functional bracing.
- 6-9 months injury prevention rehabilitation to prevent subsequent injuries.
Recovery from an ACL reconstruction can take on average 6-9 months including full rehabilitation to restore range of motion, strengthen the muscles and recover balance. Contact Dr. Joe Cooper at JoeCooperMD.com in Los Angeles CA to schedule a consultation today.
