REHABILITATION PROTOCOL OF ACL INJURY

REHABILITATION PROTOCOL AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
PHASE 1 : Week 0-2
Goals-
• Protect graft fixation.• Minimise results of immobilization.• Control inflammation.• No CPM.• Achieve full extention, 90 amount of knee flexion.• Educate patient about rehabilitation progress.
Brace-• Kept in extention for ambulation & sleeping
Weight bearing-• Standing and walking with 2 cruthes.• Discontinue crutches as tolerated after 7 days.
Therapeutic exercises for acl knee injury-• Heel slides / wall slides.• Quadriceps sets, hamstrings sets [electrical stimulation as needed].• Patellar mobilisation.• Non-weight bearing gastrocsoleus, hamstring streches.• Sitting assisted flexion hangs. • Prone leg hangs for extension.• Straight leg raises(SLR) all planes with braces entirely extension untill quadriceps strength will prevent extention lag.
Functional training-
Proprioception• Active / passive joint positioning.• Balancing activities.• Stable platform, eyes open.• Stable platform, eyes closed.• Seated ball throwing and catches.
PHASE 2 : Week 2-4
Goals-
• Restore normal gait
.• Restore full ROM.• Protect graft fixation.• Improve strength, endurence and proprioception to organize for functional activities.
Weight- bearing• Patellar tendon graft- continue ambulation with brace kept in extension.• Hamstring graft and allograft- may discontinue brace use when normal gait pattern and quadriceps control are achieved.
Therapeutic exercises acl knee injury-• Mini-sqats 0-30 degrees.• Stationary bike (start with low tension and seat).• Closed chaion extension (leg press 0-30 degrees).• Toe raises.• Continue hamstings streches, progress to standing and walking gastrosoleus streches.• Continue prone leg hangs with progressively heavier ankle weights untill full extension is achieved.
Functional training-
Aerobic conditioning-• Continue upper extremity ergometry.• Advance to two-leg bicycling.Plyometrics / eccentric muscle training-• Stair walking- up/down, forward/backward.Aquatherapy-• Pool walking.• Pool jogging (deep water running).Proprioception-• Balancing activities.• Unstable platform (Kinesthetic Ability Training or Biomechanical Ankle Platform Mother board) with eyes open/closed.• Mini-tramp standing.• Standing ball throwing and catching.
PHASE 3 : Week 6- month 4
Goals-
• Improve confidence within the knee. • Avoid overstreching graft fixation.• Protect the patellofemoral joint.• Progress strength, power and proprioception to organize for functional activities.
Therapeutic exercises acl knee injury- • Continue flexibility exercises as appropriate for patient.• Advance closed kinetic chain strengthening (one the squat,leg press 0-60 degrees).• Elliptical stepper, stair stepper.• Cross-country skiing machine.
Functional training- (6-12 weeks)
Aerobic Conditioning• Continue bicycling/ upper extremity ergometry.• Stair stepper/ elliptical stepper.• Pool walking/ jogging.• Cross-country skiing machine.Plyometrics• Stair jogging.• Box jumps 6-12inch heights.
Running• Figure of 8 pattern.• Straight ahead walking, progressing to running.• Large circles, walking and slow jogging.Proprioception• Mini-tramp bouncing.• Pogowall balancing.• Lateral slide board.• Ball throwin and increasing in popularity unstable surface.
PHASE 4 : Month 4
Goals-
• Go back to unrestricted activities.
Therapeutic exercises acl knee injury-• Continue and progress flexibility and strengthing programs.
Functional training-
Aerobic Conditioning• Continue bicycling/ upper extremity ergometry.• Stair stepper/ elliptical stepper.• Pool walking/ jogging.• Cross-country skiing machine.Running• Figure of 8 pattern.• Small circles and running.Agility• Start at slow speed, advance slowly.• Shuttle run.• Lateral slides.• Carioca cross-overs.• Cutting drills.Proprioception • Reaction drills.• Advanced sport-specific drills (full speed).Plyometrics• Advance heights
PHASE 5 : Go back to Sports
Goals-
• Safe returns to athletics.• Maintain strength,endurence and proprioception.• Patient education concerning any possible limitations.
Brace-• Functional brace might be recommended by physician for use during support for the 1-2 year after acl knee injury for psychological confidence.
Therapeutic exercises acl knee injury-• Gradual go back to sport participation.• Maintaince program for strength and endurence.• Agility and sport specific drills progressed.
Protection against ACL knee injury
Use proper techniques when playing sports or exercising. Several women's college sports programs have reduced ACL tears via a training program that teaches athletes how you can minimize the stress they put on their ACL.
Although the concern is controversial, the use of knee braces during aggressive athletic activity (for example football) has not been proven to decrease the incidence of knee injuries and could give the player an incorrect sense of security.