The absolute cheat’s guide to ACL anterior cruciate ligament rehabilitation
This is information for those patients that have had surgery to reconstruct their ACL and wish to perform their own rehab.
The best advice after surgery is to elevate your leg when at rest. This will be for about 2 weeks after surgery but especially in the first week. It must be 60cm higher than your head.
This helps greatly to reduce pain and stops swelling and bleeding from tracking down the leg under the skin. Of all the things to do after the operation elevation is the most important. If you do this you will avoid a lot of trouble caused by swelling. Icing alone will not reduce the swelling significantly and I can’t stress enough how important elevation is.
Put ice on you knee if you find it helps. It is good for reducing pain. Limit the time that you put on ice to 20 minutes in the hour and put a cloth between the skin and the ice as to apply ice directly to the skin may cause frostbite.
You will usually have a prescription for pain killers. Take these as you need them. The prescription will say to take them at the full dose but if you do not have pain then there is no need to take them. Be aware that the tablets are likely to cause nausea and constipation.
Practice tightening your quadriceps by trying to straighten the knee. Put considerable force in to straightening the leg and do not be worried that you will damage anything.
Do a straight leg raise if you can. Hold it for 10 seconds. It does not really matter how long you hold it or how often you do it. When you think of it do it.
Practice bending your knee to 90 degrees. This is best done when you are sitting down and you can slide the foot under the chair on a tiled or timber floor. Take your time doing this and allow a chance for the tissues to relax and stretch. Again do not be afraid that you will do any damage.
5 minutes a day will do on this.
Rest a lot and keep the leg elevated when at rest. Have it that the pillows are positioned on your sofa so that you can put your leg up without having to set it up each time. You can also go for short walks for a few minutes with the crutches. Put about 50% of your weight on the leg and 50% of your weight on the crutches. You do not have to be too exact about this.
You will have a clinic appointment about 1 week after your surgery. At the appointment the wounds will be checked and the parts of the stitches on the outside will be cut. There are no stitches to come out of the wounds as they are absorbable.
After the 1st week practice transferring your weight to the operated leg when standing.
Stand behind a chair so that you have something to hold on to. Sway over to the operated side so that you are taking more weight on the operated leg. Then raise the non operated leg off the ground and practice standing on the operated leg only while holding on to the chair. You will now be taking all of your weight on the operated leg.
Continue going for short walks using the crutches.
After the 2nd week or sooner if you like you can start to bend the knee fully. You can push this but don’t make it too sore.
It may take you up to 4 weeks after the operation before you can flex the knee fully. Indeed the last bit of flexion may not be there for some months but do not worry about that. Now after 4 weeks you can start leaving off the crutches for short walks around the house and you can get rid of them altogether when you are confident.
For the next 5 weeks up to 9 weeks after the surgery you will just be going for short walks of 15 to 20 minutes. There is no need to get too obsessive about this and there is no need to stick to any serious schedule. The graft is healing to the bone in your knee and developing a blood supply during this period. This is not dependent on you doing any special exercises. It is occurring naturally.
You will have another clinic appointment at 6 weeks. At this appointment you should have a full range of movement in the knee and walk with no limp. In reality you may be short a little in full flexion. There may be some fluid in the knee but this will go in time.
At 9 weeks after the operation and no sooner you can start cycling. Do it for as long as you like and there should be no great strain on the knee at first. To do cycling sooner I believe risks stretching the graft as it has not completely attached to the bone yet. A stretched graft will not retighten.
Start doing single leg squats and hamstring bridges. Set up your own programme for this. It needs to be a bit strenuous but you don’t need to kill yourself. Again discuss these exercises when you are in for your follow up appointment.
At 12 weeks after the surgery you can do easy running for 10 to 15 minutes. As often as you like and as much as you like really. There is no need to overdo it at all. Remember it is the rest days that are important to build up the muscle. Every second day running will be fine and you can take 2 days off in a row if you want. If you like swimming and cycling you can do these as well. The weight bearing aspect of running is good for the knee.
Continue the single leg squats and the hamstring planks.
At 16 weeks you will be doing faster running again for 10 to 15 minutes. Tailor this to suit your own level of fitness.
At 20 weeks you can start doing shuttle sprints. Make up you own programme. Maybe jog for 60m then hard sprint for 60 m, then rest. Do 4 to 6 sets of these. You can do your own thing. Basically jog, hard sprint, rest, and repeat. Again take a days rest between sessions to allow a chance for the muscle to develop.
Practice single leg hops. Start in the centre of the clock and jump out to the hours in sequence. Mix it up if you like. This exercise improves you balance. Strength is useless without balance.
You can start sports specific training on your own. Typically ball work. Kicking or pucking the ball against a wall, catching it. Getting your eye back in
At 26 weeks you can get back to training with your club but no contact yet. You can do the drills in training. Practice jumping and landing if this is an important aspect of the sport you play. Practice landing on both feet with the knees slightly bent. Concentrate on keeping the knee in line with the front part of your foot. Land softly and let the knees flex a little to absorb the force.
Over the next 6 to 10 weeks you can consider contact sport as your confidence grows.
You will have another clinic appointment at about 6 months after the operation.
At this stage it can be useful to have a Biodex isokinetic test to see how strong your muscles are. This will show how strong your quadriceps and hamstring muscles are and also how they are performing. You can then work on the areas that need more attention.
In general it is likely that it will be 6 to 12 months before you will return to your sport. The knee continues to improve over time and after 2 years you will feel that it is better,
Contact us for any comments please on this rehab advice. Please ask for a demonstration of the exercises when you come back for your follow up.