Rehabilitation After ACL Surgery

ACL Surgery And Physiotherapy

Physiotherapy ultimately plays a crucial role in the outcome of any ACL surgery. Following a successful surgical procedure much of the success will fall on the patient’s dedication to their therapy and the physiotherapists ability to both motivate and appropriately progress their rehabilitation program up until a full return to pre-injury levels.  Orthopaedic surgeons typically have their own specific post-surgical protocols for how they wish their patients post-surgical rehabilitation to be managed following ACL surgery.  Although there are slight variations in in the approach of each surgeon as a rule most surgeons will want physiotherapy treatment to begin within the first 10 days post operatively and guide the patient through the next 9-12 months as they work towards achieving their pre-injury activity levels.

The Early Stages Of ACL Surgery Physio Rehabilitation

Any initial post-surgical physiotherapy treatment in the first couple of weeks following surgery is generally focused around reducing swelling, gait re-education, achieving appropriate muscle activation and improving knee range of movement (ROM).  As the rehabilitation stages progress the focus moves from being swelling and ROM focused towards being more concerned about regaining balance and postural control, strength, endurance, and correct neuromuscular control. All of the above ultimately needs to be restored prior to any return to sport around a year down the track.
In sport around 70% of ACL injuries occur through non-contact mechanisms with only 30% resulting from the direct contact with another player, or object.  Henceforth just because you may not be returning to a contact sport following ACL surgery this does not necessarily mean you can return to sport any sooner, as the mechanism of injury is often associated with the forces of deceleration, coupled with cutting, pivoting or sidestepping maneuvers, as well as awkward landings.  And this is more the case than any actual physical contact with someone, or something.  Therefore if the patient does not have the strength, balance, postural control, neuromuscular control, or endurance to maintain ideal biomechanics and motion throughout the entire exercise period, they are putting themselves at a higher risk of a heartbreaking re-injury.  Which for me as a physiotherapist (and I’m sure also for any orthopaedic surgeon) is one of the most disappointing things to hear, is someone who has gone through the rehabilitation process and then returned to sport and suffered a re-rupture of their ACL reconstruction.

Fast Tracking The Process With Accelerated Rehabilitation Programs

New surgical techniques and stronger graft fixation have played a role in the development of accelerated rehabilitation programs.  Such programs allow for a quicker return to a patient’s pre-injury activity levels, yet, again if the patient has not done the hard work during the rehabilitation period then they are putting themselves at a greater risk of suffering re-rupture.  It cannot be emphasized enough that simply waiting for the 9-12-month post-surgical time frame to tick over before returning to sport is not responsible management because time alone will not rehabilitate the knee.  The best chance of a successful return to full activity following ACL surgery, and avoiding the disappointment of re-rupture is through the strict adherence to the post-surgical protocol guided by a physiotherapist.

Rehabilitation Programs Backed By Research

Over the years, a lot of work and research has gone into the development and structuring of rehabilitation and knee injury prevention programs, with the goal of reducing injury, and re-injury rates.  Two such programs that have been shown to significantly reduce re-injury rates when returning to side stepping sports are the http://smsmf.org/smsf-programs/pep-program and the http://f-marc.com/11plus/exercises/
Regarding the FIFA 11+ program it should be performed from around the 6-month mark (depending on individual circumstances). Once the surgeon has given the “all clear” to start one of these programs like the FIFA 11+ then they are generally carried out for a period of a three months which when on an accelerated post-surgical protocol coincides with the goal of a return to play at around 9-months post-surgery.  Interesting to note is that around only 30% of ACL surgery reconstruction patients will return to their pre-injury level of sporting competition by the 12-month mark.  And that psychological factors are predictors of a return to sport, where the patients view regarding their ability to return to play is a strong predictor for them returning to pre-injury competition level, within the typical rehabilitation time frames.  I would suggest that adhering to either of these above rehabilitation programs would set you up both psychologically and physically in good stead to return to pre-injury level by the 12-month mark.  At least, certainly more so than patients not committing to either of these (or, similar) comprehensive rehabilitation programs.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding “ACL Surgery” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.