| Note on research and authorship Rehabilitation, requiring months of intense exercise, is recommended for successful recovery from a surgical repair of the anterior cruciate ligament. Rehabilitation following anterior cruciate ligament repair follows a structured process beginning immediately after the surgical repair and ending with the individual returning to work and other activities (Ageberg; Mikkelsen). The entire process can take up to 9 months.
Phase 1: Initially in Phase 1, the physical therapist uses modalities, such as cold packs, to decrease postoperative pain. The physician may request very gradual weight-bearing immediately after the anterior cruciate ligament repair. A rehabilitation brace, also called a postoperative brace, is used immediately after surgical repair in an effort to put the joint at rest and help protect it while still allowing appropriate but limited motion. This form of bracing is available in two particular types: a straight immobilizer and a hinged brace. Straight immobilizers are made of foam with two metal rods down the side that are secured with Velcro and prevent all motion. The hinged brace allows range of motion to be set by tightening a screw control.
Once pain and swelling are controlled, range of motion is started in rehabilitation and performed as tolerated, as guided by the surgeon. This phase continues with isometric exercises, such as the quadriceps set. Ankle range of motion of the involved lower extremity should be encouraged intermittently throughout the day to promote blood circulation. By the end of this phase, crutch walking should be easily tolerated.
Phase 2: This phase usually begins at the end of immobilization, when swelling is controlled and pain is minimal. Goals of rehabilitation are to achieve full and pain-free motion of the knee joint along with strengthening of, in particular, the quadriceps and hamstring muscle groups, and all muscles in the involved leg (Liu-Ambrose).
Phase 3: This phase is considered the intermediate stage of rehabilitation. The criteria for beginning Phase 3 is no swelling, minimal to no pain and almost full range of motion. The individual is encouraged to walk, with weight bearing restrictions as indicated by the surgeon, and may be allowed to return to light work. For some individuals, this phase may not be reached for several months longer. More intense exercising, with increased resistance, is called for during this phase. Cycling and proprioceptive exercises may be attempted at this time.
Phase 4: In this phase, resisted exercise is initiated by the therapist. At the completion of Phase 4 of the rehabilitation for anterior cruciate ligament repair, the individual should have full range of motion, no symptoms, and functional stability with the involved limb demonstrating no more than 10% deficit of strength compared to the uninvolved leg.
Phase 5: This phase focuses on the individual's reinstatement to work as exercise is now directed toward work requirements. The physician may prescribe a brace to be worn by the individual at the onset of resuming functional activities, when the individual returns to work, training, or competition.
Generally speaking, rehabilitation of the anterior cruciate ligament will vary depending on the type of surgery that was performed, the location from which the graft was harvested, and whether any associated supporting ligament and cartilage were also injured and/or repaired.
Additional information may provide some insight into the rehabilitation needs of these individuals (Thomson; Wu). |