Understanding ACL
An ACL injury is the tearing of the anterior cruciate (KROO-she-ate) ligament (ACL)– among the major ligaments in your knee. ACL injuries most frequently take place throughout sports that include abrupt stops, jumping or reversals– such as basketball, soccer, football, tennis, downhill snowboarding, volleyball, and gymnastics.
Meniscus Surgery
Knee arthroscopy is one of the most commonly carried out surgical procedures. In it, a mini electronic camera is inserted through a small incision (portal). This supplies a clear view of the inside of the knee. Your orthopedic surgeon inserts miniature surgical instruments through other portals to trim or fix the tear.
General Considerations
- It is essential to acknowledge that all times are approximate which progression should be based on careful tracking of the patient’s functional status.
- Early emphasis on attaining complete hyperextension equivalent to the opposite side.
- Patients will be in a hinged knee brace for four weeks post-op locked in full extension.
- No active knee flexion X 4 weeks.
- Partial/ toe-touch weight bearing for 3-5 days post-op, increasing to full weight bearing– essential to watch for lower leg rotation or “heel whip” with ambulation to prevent stress onto the meniscus.
- No lateral exercises for 12 weeks with resistance, no ballistic or pivoting activities for six months post-op.
- Routine manual treatment ought to be performed to all incisions so that they remain mobile.
- Exercises should focus on the early recruitment of the quadriceps specifically VMO.
- No withstood leg extension devices (isotonic, isokinetic, or handbook withstood) at any point.
- Patients are provided a practical assessment/sports test at 3, six months, 1-year post-op.
- OK to sleep without a brace.
- No direct palpation to surgical portals x 4 weeks; consider the edges of the plasters as the “no touch zone” around 2 inches from all entrances. See injury care procedure for additional detail.
Expectations after the ACL and Meniscus Surgery
Week 1
- Nurse see day two post-op to change the dressing and evaluate a home program.
- Icing and elevation every 2 hours for 15-20 min sessions.
Manual
- Effleurage for edema. Soft tissue treatments and mobilization to all associated musculature (quads, hamstrings, gastrocnemius, popliteal fossa, ITB).
- Patellar moves all instructions; avoid palpation of surgical portals x 4 weeks.
- Passive “dangle” edge of the bed for knee flexion variety of movement; enable leg to bend as much as 90 degrees in pain-free variety 4X/day for 5 minutes.
- Focus knee extension variety of movement equal to 0 degrees.
Exercises
- Straight leg raise workouts (lying, seated, and standing), quadriceps/abduction/ gluteal sets; balance/proprioception workouts; well-leg fixed biking; upper body conditioning.
- Once or twice daily: open-chain flexion of the knee to end variety per client tolerance.
- Can begin double leg standing calf raises and stretches.
Goals
- Remove pain, edema.
- Brace locked in extension x 4weeks for weight using.
- Touch down weight bearing x 3-5 days, progress to complete weight bearing with good mechanics.
- Passive series of motion 0-90 degrees.
Weeks 2 – 4
Nurse visit at 14 days for suture removal and check-up.
Manual
- Continue with soft tissue mobilization, patellar glides, series of movement.
Exercises
- Continue with previous exercises; boost core/gluteal strength. Balance/proprioception exercises (e.g., single leg standing balance). Activate quads to maintain knee extension.
- Aerobic exercises consisting of upper body ergometer, well legged fixed biking.
Goals
- Continue to decrease pain.
- Brace locked in extension for weight bearing, progress to complete weight bearing.
- Passive series of movement 0 to 90 degrees.
Weeks 4 – 6
- M.D. go to at four weeks, discontinue using the post-op brace.
Handbook
- Continue with soft tissue mobilization to surrounding musculature, patellar glides.
- Light joint mobilizations and scar mobilization if websites closed.
Exercises
- Can begin regular withstood leg training with weight devices without symptoms.
- Fixed cycling, the mindful intro of stair machine.
- Can begin pool workouts and swimming without the brace (can use a brace for support if desired) as soon as websites are completely closed.
Goals
- Stop post-op brace. Can initiate stationary biking.
- Active range of movement 0-120 degrees.
Weeks 6 – 8
Manual
- Continue with above manual as needed, boost series of motion.
Exercises
- Increase the strength of practical exercises (i.e., stretch cord resistance, including weight, increasing the resistance of aerobic devices).
- Roadway cycling as tolerated.
Goals
- Initiate roadway cycling.
- Full variety of movement of the knee.
Weeks 8 – 12
- Add lateral training exercises (i.e., lateral stepping, lateral step-ups, step-overs).
- Development proprioceptive and balance exercises, increase vibrant challenge.
- Start to integrate sport-specific training (i.e., beach ball bumping, light soccer kicks and ball skills).
Goals
Full knee range of motion. 5/5 muscle strength in the surgical leg.
Initiate sport-specific training.
Weeks 12 – 16
- Total Sports Test 1; start pre-running program (see extra handout for specific information).
- Incorporate bilateral leaping and bounding workouts, ensuring to expect countervailing patterns and any signs of increased pronation and/or valgus moment with liftoffs or landings.
- Patients should be weaned into a home program with a focus on their specific activity.
Goals
- Complete and pass Sports Test 1, initiate pre- running drills/plyometrics.
Weeks 16 +
- Start going back to running program.
- Sagittal airplane plyometric training focuses on type and control.
- Working towards single leg plyometric training.
KEEP IN MIND: All developments are approximations and must be used as a standard just. Progression will be based on private patient presentation, which is assessed throughout the treatment process.