ACL reconstruction and Rehabilitation

1. ACL Reconstruction and Rehabilitation

2. Anatomy • The knee joint is a hinge joint formed by bones-femur tibia and patella and is held together by ligaments. • There are four ligaments and they are: MCL (medial collateral), (LCL) lateral collateral, (ACL) anterior cruciate and (PCL) posterior cruciate ligament.

3. Anatomy • All these ligaments provide stability to the joint. The weight bearing surface of the knee is covered by articular cartilage • The medial meniscus and lateral meniscus between the cartilage surface of femur and tibia and they act as shock absorbers

4. Statistics • Most often anterior cruciate ligament (ACL) of the knee is injured. It is estimated that about 200,000 injuries occur annually and about 100,000 ACL reconstruction surgeries are performed. • The incidence of ACL injuries is higher in people who participate in sports such as basketball, skiing, foot ball and soccer.

5. How does it occur? • . About 70 % occurs - non-contact mechanism About 70% percent occurs due to direct contact with an object or a player

6. Does Physical Therapy help? • Proper rehabilitation and progressive physical therapy may help to restore the patients to pre- injury state. • A physical therapist may also educate the patient how to avoid future injuries. • Patients can avoid surgery however it may cause secondary injury to knee due to recurring instability episodes.

7. Who can avoid surgery? • Patients who have partial tear and do not have any instability symptoms • Patients who have complete tear and do not show any knee instability symptoms during low demanding sports, who are willing to give up high demanding sports. • Patients who do light manual work and who have a sedentary life style • Mostly children who have their growth plate still open

8. Physical Therapy Before Surgery • Physical therapy plays a crucial role in successful ACL surgery • Usually patients are sent to a physical therapist. The main goal of the therapy session is to attain the full range of motion. Patients who have stiff, swollen knee during surgery may have problems regaining motion post surgery. It takes 3 or more weeks to gain full range of motion after the initial injury. Braces are recommended during this time so that the injury may heal before the surgery

9. Physical Therapy After Surgery • After the surgery, precautions are taken to keep the wound dry and clean. Initially, physical therapy sessions emphasis on straightening knee and resorting quadriceps control. • Ice is used to reduce swelling and pain. Physician determines if crutches and post operative braces should be used. • The primary goal of physical therapy is to attain full range of motion as well as strengthening quadriceps and hamstring muscles while keeping swelling and pain under control.

10. Physical Therapy After Surgery • Once the patient attains full range of motion and strength, physical therapy session may concentrate on endurance and functional training. • Exercises which improve neuromuscular control are also included in regime to increase patient’s sense of balance and control. • The rehabilitation program after surgery may take up to 6 months depending on the circumstances.