The goals of the first days after ACL reconstruction are to minimize swelling and prevent discomfort. This can be accomplished with:
- Icing frequently
- Elevating the affected knee
- Using crutches
Some surgeons recommend the use of a brace after ACL surgery. This is controversial, and many surgeons choose not to use a brace at this time.Another controversial subject is the use of a CPM, or motion machine, after surgery. Again, some surgeons will use the CPM despite a lack of evidence that it helps your recovery.
Range of motion exercises can begin immediately after surgery. The initial focus is to regain full extension (the ability to fully straighten) of the knee. In general, flexion (ability to bend) is much easier to regain than extension.Patients will work with physical therapists to work on gait training (walking), gentle strengthening, and aerobic work. I like to get patients on a stationary bicycle as soon as possible after surgery as this improves strength, motion and aerobic activity.
Work is continued with physical therapy. As motion increases, emphasis is shifted to strengthening. Specifically balance and proprioceptive exercises.Once normal motion has been achieved, some sport-specific activities can be started. Before beginning these activities, motion must be near normal and the swelling in the knee gone.
Early sports activities can be started and patients can often begin light jogging, cycling outdoors, and pool workouts. Side-to-side, pivoting sports – such as basketball, soccer and football – must be avoided.
Toward the end of this phase, some athletes can begin shuttle runs, lateral shuttles and jumping rope.
Continued progression with sports specific activities. This phase of rehabilitation is often the most difficult, because patients may have a knee that “feels” normal, but is not ready for the stresses of some sport activities.Emphasis of rehabilitation should be on sport simulating activities. These will include figure-of-eight drills and plyometrics, and over time will include sport drills. For example, a tennis player may start light hitting, a soccer player some controlled dribbling, etc.