Regaining Mobility and Strength
There are many advantages to using an autogenous graft from the contralateral (opposite) bone-patellar tendon-bone. Besides strength and healing time, taking the graft from the opposite knee allows for a faster rehabilitation. Here’s why. Taking a third of the patellar tendon will cause a temporary loss of strength. It does not cause loss of range of motion. On the other hand, the leg with the ACL reconstruction is susceptible to loss of range of motion. It does not lose strength. So, there are two issues that must be addressed: loss of strength on the graft side and loss of range of motion on the ACL side. Rather than subject the same leg to both problems which must be addressed consecutively (three months on range of motion, and then three months on strengthening), our rehab program begins on regaining strength to the graft leg and range of motion to the ACL leg, immediately. This approach of rehabilitating both legs at the same time allows for quicker return of strength and range of motion, getting the patient back to their life fast—typically, in three months.
Rehab begins just out of surgery where the patient is expected to perform one cannonball (pulling the heels to the buttocks) every hour while the water in the CryoCuff is being changed. This obviates stiffness after knee surgery. The next day the patient comes into the clinic, has their dressings changed, and gets their postop X-rays. The patients are further instructed about the rehab protocol.
Week 1
The major goal of the first week of rehab is to keep or gain range of motion in the ACL leg and gain strength in the graft leg while recovering mentally and physically from the surgery. Gait training (walking) is also emphasized so that the patient does not develop a biomechanically incorrect gait. To meet these goals, patients perform the following exercises three times each day: unweighted leg extensions, lying leg lifts, standing leg curls, hip abduction, gait training, leg presses on the Shuttle™ MiniClinic, cannonballs, and prone hangs. Whenever the patient is not performing these exercises, he/she should be laying in bed with their legs elevated eight inches above their heart and with the Cryocuffs on. On day 4, patients begin riding the stationary bike for 30 minutes twice a day. This exercise greatly improves the circulation to the legs, removes waste products, and brings in new blood and nutrients that aid in healing. It also helps warm up the knees and makes the exercises easier. The Step Box is also introduced to the routine at this time. Patients perform “step ups” at one of 4 levels (2”, 4”, 6”, or 8”) depending on their ability at the time. This closed-chain exercise aims to improve strength and stability in both knees.
Weeks 2-4
During this time, the patient continues the same activities started on day 4. In addition, the patient will begin body weight squats and some stair ascending/descending while still focusing on maintaining or gaining range of motion in flexion and extension. Out of town patients will stay in contact with the clinic’s certified trainers and see a therapist near their home or athletic trainer at their school.
Weeks 5-10
By week 5, most patients are ready to begin or have already begun more demanding exercises that focus on improving stability and strength. These include exercises such as leg presses, body weight squats, plyometrics, calf raises, aggressive gait training, and ascending/descending more than 10 flights of stairs. Sport specific exercises are begun at this time as well.
Weeks 10 and Beyond
By this time, two and a half months postop, the patient will probably cease to visit our clinic or their therapist if out of state. Most of the rehabilitation program will have been established by now and it is just a matter of strength and conditioning, which is completed at the local fitness facility by themselves or with a personal trainer. Drills specific to an athlete’s chosen sport are continued.
3 Months
The patient is ready to return to sports! It is important that the patient continues with their strength and conditioning exercises not only to improve athletically, but also to try and prevent new injuries.
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