Therapy Programs: Special Rehab | ACL Rehabilitation
In the not so distant past, a tear of the anterior cruciate ligament (ACL) led to a greatly restricted lifestyle, but thanks to a greater knowledge of the benefits of early physical rehabilitation, as well as better surgical techniques, patients can now expect to recover most, if not all, of their function. Jamal Anderson of the Atlanta Falcons and Terrell Davis of the Denver Broncos both tore their anterior cruciate ligaments in the 1999 season and subsequently underwent surgical reconstruction. In years past, these young men would have had little, if any, chance of returning to the NFL, but through the improved surgical techniques and aggressive physical therapy, they went on to play agin in the 2000 season.

Why is the anterior cruciate ligament so important? Well, without it, the two main bones of the knee move more than normal. This is similar to a wobbly leg on a table. Patients with this type of injury typically describe a phenomenon known as "giving way". Quite often, injured individuals can learn to compensate for the torn ACL by avoiding activities in sports which require pivoting and planting. Others, however, are unwilling to make such a sacrifice. In addition, many in the medical community also believe that the "looseness" in the knee joint can lead to premature wear and tear of the cartilage. For this reason, many opt for surgical reconstruction of the anterior cruciate ligament.

What is sometimes confusing is that the anterior cruciate ligament is not technically repaired, but reconstructed. The ligament is typically not able to be sutured back together after it is torn and for this reason it is removed and replaced with an alternate structure. The most common structure which is used is part of the patellar tendon. The patellar tendon connects the kneecap to the tibia and is initially fixated with two screws or buttons. Eventually the bone plugs on the ends of the graft solidify within the tunnels which are drilled into the femur and tibia. Quite often, part of the hamstring tendons are also utilized. In addition, some synthetic ligament augmentation devices have also been used, but these are less common. This is something that you will discuss with your orthopedic surgeon.

Following surgery, your physician will send you to physical therapy. Some surgeons actually send you the following day while others wait one or two weeks. During the early phase of rehabilitation, we are primarily trying to decrease swelling, restore range of motion, and develop the ability to contract the quadriceps and hamstring musculature. Achieving full knee extension as soon as possible is very important in order to prevent future complications. Your incision site is where infection can enter. For this reason, you must not soak this area for at least ten days and should avoid getting it wet for the first two to three days following surgery. You should watch for areas that are not healing and for drainage.

Your weight bearing status in this initial phase will vary depending upon your physician's protocol. More aggressive surgeons will often let the patient weight bear as tolerated without a brace or assistive device as soon as you exhibit fairly good quadriceps contraction and only minimal limp. Other physicians are more conservative and will tend to keep you partial weight bearing in your brace for a few weeks.

If the graft your physician used was your patellar tendon, it tends to weaken after surgery until 8-10 weeks and then gradually tends to increase in strength. This means that as you start to feel better, 4-6 weeks after surgery, you still must be very careful in order to prevent the graft from being damaged. Your physical therapist will guide you through this delicate period.

During your second phase of physical therapy and rehabilitation, you will focus on regaining strength, maintaining your mobility, and improving your coordination in a protected manner. By "protected", we mean utilizing a brace if ordered by your physician, as well as restricting what activities you can perform. This will definitely limit your ability to perform pivoting and planting types of activities. This means no racquetball, basketball or tennis during this time frame.

During the final phase, your rehabilitation will become more functionally oriented with a gradual return to sports participation or work-related activities. Typically, patients are allowed to perform non-pivoting sports activities by three months and all sports (including those involving contact) by six months. Patients must keep in mind that these are general time-frames and certain criteria need to be met before the patient is allowed to progress to certain activities. For example, if a patient does not have full range of motion and is still exhibiting a slight limp when ambulating, it would be best if that patient did not begin running. Again, your physician and physical therapist will ultimately determine when you can begin certain activities.

It has been scientifically shown that early rehabilitation is needed in order to facilitate a good recovery. Oftentimes it is difficult for a patient to determine which postoperative symptoms are normal and which are not. Your physician and physical therapist will assist you with all of your questions and concerns throughout the rehabilitation process.