Sanders Clinic, Orthopaedic Surgeon Dr. Mark Sanders

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      THE SANDERS CLINIC
      DR. MARK SANDERS
      OUT OF TOWN PATIENT INFORMATION
      ARTHROSCOPIC SURGERY
      ACCELERATED ACL REHABILITATION
      RECONDITIONING PROGRAM
      CERTIFIED TRAINERS
      TESTIMONIALS
      COMMON ORTHOPEDIC PROBLEMS
      OCCUPATIONAL INJURIES
      FAQ
      CONTACTS
      SHOULDER
      ROTATOR CUFF TEAR
      AC JOINT INJURY & CLAVICULAR FRACTURES
      SHOULDER INSTABILITY
      ELBOW
      WRIST
      DISTAL RADIUS FRACTURES
      SCAPHOID FRACTURE
      ANKLE
      KNEE
      TORN CARTILAGE (MENISCUS)
      ANTERIOR CRUCIATE LIGAMENT (ACL)
       ACL RECONSTRUCTION
       PRE SURGERY PREPARATION
       MEDICATION
       WOUND CARE
       REGAINING MOBILITY & STRENGTH
       PRECAUTION
      PEDIATRIC ACL RECONSTRUCTION
      SALVAGE OF PREV. FAILED ACL SURGERY
      POSTERIOR CRUCIATE LIGIMENT (PCL)
      MEDICAL COLLATERAL LIGIMENT (MCL)
      ARTICULAR CARTILAGE LESIONS
      PATELLOFEMORAL DISORDERS
      ARTHRITIS OF THE KNEE
      TOTAL KNEE REPLACEMENT
      TERRIBLE TRIAD
      FRACTURES AND DISLOCATIONS
      PRESS RELEASES
      ARTICLES
      WHATS NEW
      SITEMAP

Regaining Mobility and Strength

Phase One (ACL Knee)
The ACL-reconstructed knee, Day of Surgery through Postoperative Day 14

Movement is one of the most important elements in a rapid recovery and return to full mobility. A number of different devices and exercises are introduced to patients through an Accelerated (ACL) Rehabilitation program in the advancement towards recovery.

Established in three phases, the first device used in this rapid recovery process is the CPM, which takes the ACL knee through the range of motion from hyperextension to 30 degrees. This is begun the same day the surgery takes place to help to maintain Range of Motion (ROM) and keep the knee higher than the heart to diminish swelling.

During the first week, and after thirty minutes of motion from hyperextension to 30 degrees of flexion, the CPM machine is set at 110 degrees of flexion and stopped for ten minutes during each waking hour in order to stretch the quadriceps mechanism and gain flexion.

In addition to this device, patients must also perform Active Range of Motion exercises in order to put their knee through a range of motion from hyperextension to a complete bend such that the heel touches the buttock. In order to accomplish this, the knee is fully extended by placing several folded towels under the heel, and a single towel held by both hands under the forefoot. As toes are pulled toward the head, assisted by the towel held in both hands, the patient pushes the back of their knee down toward the bed. This enables physiologic hyperextension, which is important for a return to sports to occur. For knee flexion, the towel is then put over the toes and held with both hands. As it is pulled, the knee bends to a point where the heel touches the buttock. Following completion of this exercise, the CPM is set to operate from hyperextension through 30 degrees flexion - and the cycle is repeated.

Phase One (Graft Knee)
(Ignore in cases of allograft or autograft from same leg)

The Graft Harvest Knee, Day of Surgery through Postoperative Day 14

Harvest of the bone-patella-bone graft does not cause much knee stiffness. But active Range of Motion exercises must also be performed on the graft leg. These exercises are done in the final ten minutes of each waking hour and are performed exactly the same way as on the ACL knee.

Exercises must be directed to the graft leg to strengthen and restore the size of the extensor mechanism after harvest of the bone-tendon-bone graft. The Shuttle is another device provided from the first postoperative day through the end of the second week to help exercise and strengthen the graft leg. The series of knee extension exercises provided by the Shuttle is done in bed. Patients perform four sets of 25 reps each day for one week on the graft leg. As the leg strengthens, the level of resistance is increased.

Mealtime Exercises-both knees in the first week while in bed.

During mealtimes, the CPM is removed and the patient sits on the bed allowing legs to dangle off the side at a bend of 90 degrees. Following meals, an active exercise is done by actively extending the ACL limb for ten reps. The same ten reps are then performed by the Graft limb.

The second half of Phase One
Postoperative day 8 through 14

On the eighth day following surgery, patients are generally able to resume regular sedentary activities and have a normal gait without crutches. Patients should continue their active exercises four times per day. A follow-up appointment is made at this time. The Shuttle is used for an additional week for 1 0-minutes four times per day, though the CPM machine may be returned if flexion of the knee is at least 110 degrees.

Phase Two
Postoperative Day 15 through 28

At two weeks, patients continue their exercise program by adding the Step Box for both legs. This simple device is used for the performance of closed chain knee extension exercises on both legs, beginning with four sets of 25 reps of two-inch excursions until fatigue each day then increasing until 50 reps can be performed. The same routine is then continued with a four-inch excursion. After the same goal is reached, the excursion is increased to six, then eight inches. Remember to do at least four sets per day on each leg. The patient may start to work in the stationary bike and/or the Stairmaster, as well as continuing with the Step Box at increasingly longer excursions through the end of the fourth week. In addition, in the fourth week, programs of jogging, swimming, and specific sports-related activities are begun.

The team of certified trainers at the Sanders Clinic then develop an ongoing exercise plan and assist in the Accelerated (ACL) Rehabilitation, to continue strengthening the injured area and surrounding muscle groups. This ensures the best postoperative results.

Phase Three
Postoperative Day 29 until return to sports

At the beginning of this phase, patients undergo Range of Motion and strength and stability assessment by the doctor and certified trainer. They then gradually begin sports-specific exercises and agility training to continue building strength and endurance. For example, an avid biker may incorporate short bike rides into an established exercise program. Through this phase, the patient begins gaining confidence in the capability of the reconstructed knee. Often times there is soreness at the graft site following a hard practice. This is self-limiting and only seems to occur in the first year. Two-a-day practices should be avoided. Many athletes are on the field in uniform four months following surgery, but will begin playing well after six months.

Certified trainers work one-on-one with the patients to continue a Reconditioning Program and establish an exercise routine that can be done both at home independently, as well as at a gym or clinic under supervision. During months three and four, patients may begin returning to sports at a restricted level. And through the remaining year, patients are periodically evaluated with strength and measurement tests.

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