1st postop visit 10-14 days postop – wound check – no sutures or staples to take out – all are dissolvable. usually we get PT setup now if patients are ‘guarding’ their knee.
1. Aggressive swelling management: ICE, ELEVATION, NSAID therapy.
2. No resistance exercises. Active ROM only: walking, stationary bike, bending and straightening.
3. Ween crutches when not limping.
2nd postop visit 5-6 weeks postop – check progress with Range Of Motion (ROM). Goal for 6-8 weeks postop is to have near full ROM. Start formal PT if none started for CLOSED CHAIN RESISTANCE ONLY.
After Week 6:
Closed chain resistance exercises only. ie stationary bike with resistance, squats, leg presses. CLOSED CHAIN means your feet stay attached to a pedal/plate/ground. OPEN CHAIN is running or a lunge etc where feet leave the the closed circuit/chain.
Until Objective Quad strength measures 90% of contralateral leg – needs to be objectively measured ie how many single leg squats or single leg presses is the non-operative “good” leg able to do compared to the operative leg….no open chain until 90%.
3rd/possible final postop visit – reassess PT progress. Confirm/re-educate on objective measure of strength and timeframes for return to sport
IF Objective quad strength >90% contralateral leg, ok to progress to open chain exercise, ie running. this may be 3-9 months postop.
NO lateralized/cutting/sports until 9-12 months postop AND quad strength recovered 100%. “Ligamentization” takes 9-16 months – you cannot rush the graft incorporation.
*** ACL Reconstruction is one of the most studied/published subjects in orthopedic surgery. There are many techniques for the surgery itself and many protocols for recovery. ***