After Your Operation

Mobility

Rehabilitation following ACL reconstructions is highly important to ensure optimal results and return to activity. Whilst in hospital you will be seen by the physiotherapist to commence the first stages of rehabilitation. Rehabilitation and overall success of the procedure can be affected by associated injuries to the knee such as damage to meniscus, articular cartilage or other ligaments.

The stages of ACL rehabilitation are as follows.

Stage One - Acute (0 to 2 Weeks)

Goals

• Wound healing
• Pain relief as necessary
• Swelling reduction and management 
• Restore range of motion - aim to achieve near full extension
• Establish muscle control
• Safe mobilisation - wean off crutches

It is important to regularly ice and elevate your knee for 20 minutes every hour or two to manage and reduce swelling. Compression such as tubigrip or a bandage can also be used. Crutches are usually used for 5-14 days, you can progressively increase the amount of weight you put through your operated leg as able. Regaining full extension is important to work on post operatively. Aim to get your knee nearly flat on the table or bed, but do not push your knee into hyperextension as this will stretch your graft. Do not sleep or rest with a rolled up towel or pillow under the knee as this will be counterproductive in achieving knee extension. Flexion will return more naturally, bearing in the mind the knee can feel stiff due to swelling and pain. Aim to have at least 60 degrees of flexion by week two and 90 degrees by week six.

Stage Two - Quadriceps Control (2 to 6 Weeks)

Goals

• Restore range of motion - full extension with flexion above 90 degrees
• Re-establish normal walking pattern
• Reduce post operative swelling 
• Develop muscle control and endurance 

During this period you will continue the same exercises as the first two weeks. It is important to allow this time for the graft to heal, being too aggressive with your rehabilitation in the early stages can lead to graft stretching. Management of swelling by regularly icing and elevating should be continued. Aim to re-establish a normal walking pattern with emphasis on extending the knee at heel strike.

Stage Three - Hamstring/Quadriceps Strengthening (6 to 12 Weeks)

Goals

• Continue to work on muscle strength with the introduction of power
• Improve balance and proprioception (perception of joint position)
• Progress to gentle running, and then gradual change of direction
• Increase stamina 

It is important to see a Physiotherapist who has experience in ACL reconstruction rehabilitation. Usually physiotherapy will commence four to six weeks after surgery, however some people may wish to visit their physio earlier to revisit their exercises. Rehabilitation is important, however it is also important to give your graft time to heal. After six weeks, stationary bike and some light swimming can commence along with introducing light weights such as leg press and light squats.

Stage Four - Sport Specific (3 to 6 Months)

• Improve leg strength and confidence
• Sport specific training and drills
• Develop running endurance, work on landing, jumping and change of direction
• Prepare for return to sport and recreational lifestyle with gradual introduction to training in team environment
• Reduce muscle fatigue and improve stamina 

Controlled sport specific activities should be included in the progression of running and gym exercises. At the four month mark, aim for straight line running/jogging progressing to learning to corner and run in a figure ‘S’ or ‘8’ pattern until progressing to tighter turning. More strength in your leg will also begin to recover.

Stage Five - Return to Sport (6 Months Plus)

• Gradual re-introduction to full training
• High level sport specific skills and exercises
• Commence game simulation
• Prepare for safe full return to sport - pass return to sport guidelines

Return to sport is dependent on the individual and requirements of your chosen sport. In general, return to pivoting type sports is anticipated between 9 to 12 months post operation. Dr du Sart will discuss your expected return to play prior to surgery.

Return to Work

Return to work will vary on the nature of your work and what was done at surgery. In general, you should plan to have at least two weeks off work to allow you to rest and elevate your leg. You may be able to return to light duties after two weeks, however it is important to remember that you may experience more swelling and pain with increased mobilisation and less elevation. Jobs that are more labour intensive may return between 6 to 12 weeks post operation depending on the duties. Dr du Sart will discuss this with you at your post-op check.

Driving

Times to return to driving will vary. If you have an automatic car and your left knee was operated on, your return to driving may be faster. However, in general, plan to avoid driving for two to three weeks after surgery. It is recommended to return to driving once you have regained motion and control of the knee and feel safe on the road. If you have concerns, you can discuss this with Dr du Sart.