ACL INJURY MANAGEMENT

                                   ACL KNEE INJURY

Conservative Management

Goals

Decrease inflammation , swelling and pain.
Restore normal ROM (especially knee extension).
Restore voluntary muscle activation.
Provide patient education for post-op rehabilitation.

TO DECREASE PAIN SWELLING AND INFLAMMATION-

Cryotherapy +elevation with the knee in full extension.
TENS/IFT .
Elastic crepe or knee sleeve.
Brace while walking.

TO RESTORE NORMAL ROM –

Ankle pumps.
Heel slides- knee flexion upto tolerance and knee extension to 0˚.
SLR– 3 way SLR(flexion, abduction, adduction).

RESTORE NORMAL MUSCLE STRENGTH-

Initially

Quadriceps setting.
Hamstring setting( 3 times more than quads setting).
Elecrical muscle stimulation to quadriceps during voluntary muscle stimulation.

Surgery after ACL knee injury

The aim of reconstruction is to restore stability of the knee.

Reconstruction techniques can be broadly split into two groups:
(i) Extraarticular reconstruction
(ii) Intraarticular reconstruction

REHABILITATION PROTOCOL AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

PHASE 1 : 
 Week 0-2 Goals-
• Minimise effects of immobilization. • Control inflammation.
• No CPM.
• Achieve full extention, 90 degree of knee flexion.

Brace- • Locked in extention for ambulation & sleeping

Weight bearing- • Weight bearing with 2 cruthes. • Discontinue crutches as tolerated after 7 days.

Therapeutic exercises for acl knee injury- • Quadriceps sets, hamstrings sets
 • Patellar mobilisation.
 • Non-weight bearing gastrocsoleus, hamstring streches.
Straight leg raises(SLR) all planes with braces in full extension.

Functional training-

Proprioception
• Active / passive joint positioning.
 • Balancing activities.
• Seated ball throwing and catches.

PHASE 2 :
Week 2-4

Goals-
• Restore normal gait.
 • Restore full ROM.
• Protect graft fixation.
• Improve strength, endurence and proprioception to prepare for functional activities.

Weight- bearing • Patellar tendon graft- continue ambulation with brace locked in extension. • Hamstring graft and allograft- may discontinue brace use when normal gait pattern and quadriceps control are achieved.

Therapeutic exercises acl knee injury--
  • Continue hamstings streches, progress to weight bearing gastrosoleus streches. • Continue prone leg hangs with progressively heavier ankle weights untill full extension is achieved.

Functional training-
 Aerobic conditioning-
• Continue upper extremity ergometry
 • Advance to two-leg bicycling. Plyometrics / eccentric muscle training-
• Stair walking- up/down, forward/backward.
Aquatherapy- • Pool walking. • Pool jogging (deep water running).
 Proprioception- • Balancing activities.

PHASE 3 :
Week 6- month 4

Goals- • Improve confidence in the knee. • Avoid overstreching graft fixation. • Protect the patellofemoral joint. • Progress strength, power and proprioception to prepare for functional activities.

Therapeutic exercises acl knee injury-  • Continue flexibility exercises as appropriate for patient.
• Advance closed kinetic chain strengthening (one leg squats,leg press 0-60 degrees).
• Cross country skiing machine.

Functional training- (6-12 weeks)

Aerobic Conditioning
• Continue bicycling/ upper extremity ergometry.
• Stair stepper/ elliptical stepper.
• Pool walking/ jogging. • Plyometrics
 • Stair jogging. • Box jumps 6-12inch heights.

PHASE 4 :
 Month 4

Goals- • Return to unrestricted activities.

Therapeutic exercises acl knee injury-  • Continue and progress flexibility and strengthing programs.

Functional training-

Aerobic Conditioning
• Pool walking/ jogging. • Cross country skiing machine. Running • Figure of 8 pattern. • Small circles and running. Agility • Start at slow speed, advance slowly. • Shuttle run. • Lateral slides. • Carioca cross-overs. • Cutting drills. Proprioception • Reaction drills. •Plyometrics

PHASE 5 :
 Return to Sports

Goals- • Safe returns to athletics. • Maintain strength,endurence and proprioception. •Patient education concerning any possible limitations.

Brace- • Functional brace may be  for use during support for the 1-2 year after acl knee injury for psychological confidence.

Therapeutic exercises acl knee injury-  • Gradual return to sport participation. • Maintaince program for strength and endurence. • Agility and sport specific drills progressed.


Prevention of ACL knee injury

Use proper techniques when playing sports or exercising.