Rehabilitation for Anterior Cruciate Ligament Injury

The anterior cruciate ligament (ACL), one of the most commonly injured ligaments in the knee, runs diagonally through the middle of the joint. About half of ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee, complicating the healing process. After the first aid treatment of rest, ice, compression and elevation (RICE), all patients with ACL injury require rehabilitation.

For some patients, physical therapy is done before and after a surgical repair. For others, the physical therapy alone is sufficient. If the patient undergoes rehabilitation without surgery, however, the knee may remain unstable during certain movements.

Nonsurgical Rehabilitation for ACL

Early therapy for ACL injury involves periodic applications of ice to reduce swelling. A knee brace is often worn for support and compression and crutches or splints may be used for a few days to keep weight off the affected knee. It is important to begin physical therapy soon after the injury occurs to prevent stiffness of the joint and muscle atrophy. Rehabilitation to help relieve pain, reduce swelling, prevent muscle spasms and increase mobility may include:

  • Electrical stimulation
  • Ultrasound
  • Light massage
  • Range of motion (ROM) exercises
  • Strengthening exercises
  • Isometric exercises
  • Exercises to improve balance
  • Proprioceptive exercises

The therapeutic routine will be adjusted to accommodate each individual patient's condition and tolerance level.

Postsurgical Rehabilitation for ACL

In order to give the patient the best chance of regaining full function of the knee, physical therapy begins right after the surgery to repair an ACL ligament. It may continue for several months until the patient is able to resume normal activities. Postsurgical rehabilitation takes place in stages as the weeks pass, a process known as functional progression.

During the first days after surgery, patients may be instructed in the use of a continuous passive motion (CPM) machine, although there is some controversy about whether this machine actually produces therapeutic results. In the ensuing weeks, rehabilitation will include some or all of the following:

  • Exercises to strengthen the quadraceps and hamstrings
  • Range of motion (ROM) exercises
  • Extension (stretching) and flexion (bending) exercises
  • Therapeutic walking
  • Ultrasound

Postsurgical rehabilitation for ACL usually takes several months. It may take a month or two more for patients to be able to fully engage in athletic activities.

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