The 4 Phases of Rehabilitation After ACL Repair Surgery

Introduction 

Anterior cruciate ligament (ACL) repair surgery is a common procedure for athletes and active individuals who suffer from ACL tears. Complete ACL tears are usually treated by sports medicine physicians and orthopaedic surgeons with an ACL reconstruction surgery, in which the torn ligament is replaced with a tissue graft to mimic the natural ACL. Holistic and interdisciplinary approach to treating ACL injuries is crucial in making sure that your ACL recovers fully. Looking for top-tier ACL rehabilitation in Malaysia? Synapse Physiotherapy is a leading expert in treating ACL tears and providing comprehensive post-operative rehabilitation. With a team dedicated to personalised recovery plans, we’re committed to helping you get back to peak performance. Our expert and professional physiotherapist will be able to correctly design your rehabilitation plan and facilitate your return to sports in the best way possible.

You may be wondering if there is a necessity to get ACL surgery, in which the answer depends on the severity of the ACL tear and the lifestyle of the patient. For example: a completely torn ACL cannot heal on its own. However, in a certain population of young patients who had experienced a partial tear of the ACL, the ligament may heal without the need for surgery. In addition, patients who only have a partial tear, non-surgical treatment may be an option.For patients who maintain an active lifestyle that have completely torn their ACL, especially for competitive athletes, it is highly recommended for surgery to allow them to return to pre-injury level of activity and avoid any further damage to the knee. Athletes who participate in cutting and pivoting sports such as soccer, basketball, football, and hockey are at increased risk of meniscus injury if an ACL is left untreated with surgery or rehabilitation.

However, in some older patients or others whose lifestyles do not include rigorous exercise with side to side movements, a non-surgical treatment may allow them to return to normal routine without an intact ACL although this varies from individual to individual. For a complete tear of the ACL, reconstruction surgery is typically scheduled between 3 to 6 weeks after injury as this allows inflammation in the affected knee to subside. The gap time also allows physiotherapy treatment to focus on restoring normal knee flexion and extension range of motion, which is one of the criteria that needs to be met before reconstruction surgery can be done.

Post-surgery rehab, a comprehensive rehabilitation program, is crucial for regaining strength, stability, and function in the knee. Proper rehabilitation can also prevent stiffness in the knee joint after surgery. Physiotherapy rehabilitation typically progresses through four distinct phases, each with specific goals and exercises to ensure a successful recovery.

Phase 1: Immediate Post-Surgery (Weeks 0-2)

 Goals:

– Protect the surgical repair

– Reduce pain and swelling

– Restore basic knee movement

– Begin muscle activation

Key Components:

1. Pain and Swelling Management:

 Rest and Ice: Apply ice regularly to reduce inflammation and pain.

Compression and Elevation: Use compression bandages and keep the leg elevated to minimise swelling.

2. Mobility Exercises:

Passive Range of Motion (ROM) Exercises: Assisted exercises to gently move the knee joint without active muscle contraction, such as heel slides.

Patellar Mobilisation: Gentle movements of the kneecap to prevent stiffness.

3. Muscle Activation:

Quadriceps Setting: Isometric exercises to activate the quadriceps without moving the knee joint.

Ankle Pumps: Promotes circulation and prevents blood clots.

4. Weight Bearing:

Crutch Use: Gradual weight-bearing as tolerated with crutches, following the surgeon’s guidance.

Phase 2: Early Rehabilitation (Weeks 2-6)

Goals:

– Restore full knee ROM

– Improve muscle strength

– Maintain patellar mobility

– Achieve normal gait pattern

Key Components:

1. Range of Motion Exercises:

Active-Assisted ROM Exercises: Exercises to increase knee flexion and extension, such as using a stationary bike with minimal resistance.

Wall Slides: To enhance knee movement.

2. Strengthening Exercises:

Closed Kinetic Chain Exercises: Such as mini squats and leg presses, which are safer for the healing ligament.

Straight Leg Raises: To strengthen the quadriceps without stressing the knee.

3. Gait Training:

Walking Drills: Focus on proper walking mechanics and reducing limping.

Treadmill Walking: At a slow pace to ensure even weight distribution.

4. Neuromuscular Training:

 Balance Exercises: Such as standing on one leg or using a balance board to improve knee stability.

Phase 3: Intermediate Rehabilitation (Weeks 6-12)

Goals:

– Increase muscle strength and endurance

– Enhance proprioception and balance

– Gradually return to functional activities

Key Components:

1. Strength Training:

Progressive Resistance Exercises: Including leg presses, hamstring curls, and hip strengthening exercises.

Core Strengthening: To support overall stability and function.

2. Proprioception and Balance:

Single-Leg Balance Drills: With added challenges such as soft surfaces or perturbations.

Dynamic Balance Exercises: Such as lateral movements and step-ups.

3. Cardiovascular Fitness:

Low-Impact Aerobic Exercises: Such as swimming, cycling, or using an elliptical machine to maintain cardiovascular health.

4. Functional Training:

Sport-Specific Drills: Gradual introduction of sport-specific movements to prepare for return to activity.

Plyometric Exercises: Light jumping and landing drills to build explosive strength and coordination.

Phase 4: Advanced Rehabilitation and Return to Sport (Weeks 12+)

 Goals:

– Achieve full strength and functional capacity

– Return safely to sports or high-level activities

– Prevent re-injury

Key Components:

1. Advanced Strengthening:

High-Intensity Resistance Training: To achieve pre-injury strength levels.

Multi-Directional Strength Exercises: Such as lunges and agility drills.

2. Agility and Plyometrics:

Advanced Plyometric Drills: Including box jumps, lateral hops, and bounding exercises.

Agility Drills: Such as cone drills, ladder drills, and shuttle runs to enhance quickness and coordination.

3. Sport-Specific Training:

Gradual Return to Sport: Supervised introduction of sport-specific activities and drills.

Simulated Game Situations: To build confidence and ensure readiness for competition.

4. Injury Prevention:

Ongoing Neuromuscular Training: To maintain balance, proprioception, and overall knee stability.

Education on Proper Techniques: Emphasising safe movement patterns and techniques to avoid future injuries

FAQs

1. How long does it take to fully recover from ACL surgery? 

Full recovery from ACL surgery typically takes 9-12 months, depending on the individual and adherence to the rehabilitation program.

2. Is ACL surgery always necessary for a torn ligament? 

Not always. The need for surgery depends on the severity of the tear, the patient’s lifestyle, and their desired level of activity.

3. Can physiotherapy alone help with ACL recovery? 

Physiotherapy is essential for recovery, whether surgery is performed or not. It helps restore knee function, strength, and stability.

4. What are the risks of not following a rehabilitation program? 

Skipping rehabilitation increases the risk of knee instability, reduced mobility, and re-injury, potentially leading to chronic pain or further surgeries.

5. When can I return to sports after ACL surgery? 

Most athletes can return to sports after completing the advanced rehabilitation phase, typically around 9-12 months post-surgery, with their physiotherapist’s approval.

Conclusion 

Physiotherapy rehabilitation after ACL repair surgery is a structured and progressive process that requires dedication and guidance from your surgeon and physiotherapist. By following the four phases of rehabilitation—Immediate Post-Surgery, Early Rehabilitation, Intermediate Rehabilitation, and Advanced Rehabilitation—patients can achieve a full recovery, regain knee function, and safely return to their desired activities. Adhering to the prescribed exercises by your physiotherapist and protocols ensures the best possible outcome and minimises the risk of re-injury.