ACL injuriesACL injuries

Kerry JacobsB Physiotherapy (Hons)

M Sports and Musculoskeletal Physiotherapy

Kerry JacobsB Physiotherapy (Hons)

M Sports and Musculoskeletal Physiotherapy

Background Background ACL prevents anterior translation of tibia on

femur, tibial rotation and varus/valgus angulation.

Injury commonly occurs in non-contact situation: landing from jump, pivoting or quick deceleration.

ACL prevents anterior translation of tibia on femur, tibial rotation and varus/valgus angulation.

Injury commonly occurs in non-contact situation: landing from jump, pivoting or quick deceleration.

Surgical TreatmentSurgical Treatment Arthroscopy Autogenous grafts

Bone-patella-boneHamstring (semitendinosus +/- gracilis)

Allografts Synthetic ligament

LARS (ligament advanced reinforcement system)

Arthroscopy Autogenous grafts

Bone-patella-boneHamstring (semitendinosus +/- gracilis)

Allografts Synthetic ligament

LARS (ligament advanced reinforcement system)

Early RehabilitationEarly RehabilitationPhase Time post

surgeryGoal of phase Exercise program Functional/sport-

related activity

Prehab N/A ↓ swelling

Full ROM

> 4+/5 strength

Gait, proprioception

Patient education

ROM exercises

VMO/quads

Hamstring and hip abd/ext exercises

Gait education, proprioceptive training

Swelling advice and activity modification

Walk

Bike-ride

Swim – no breastroke

Phase 1 0-2 weeks PWB-FWB

↓ swelling

0-100° ROM

> 4+/5 quads strength

5/5 hamstring strength

Proprioception

Education

Gentle flexion ROM

Extension ROM 0 °

Quads/VMO setting

Bilateral calf raises

Hip abd/ext

Hamstring pulleys/bands

Gait drills

Proprioceptive training

Nil

Phase 2 2-12 weeks No swelling

Full knee hyperextension

Knee flexion 130 ° +

Full squat

Good balance/control

Unrestricted walking

ROM drills

Quads/VMO

Mini squats/lunges

Leg press (double to single)

Step-ups

Bridges (double to single)

Hip abd and ext with rubber tubing

Single-leg calf raises

Gait re-education drills

Balance/proprioceptive drills (single leg)

Walking

Exercise bike

Mid-Late RehabilitationMid-Late Rehabilitation

Phase Time post surgery

Goal of phase Exercise program Functional/sport-related activity

Phase 3 3-6 months Full ROM

Full strength/power

Return to jogging, running, and agility

Return to restricted sport-specific drills

As above – increased difficulty, repetitions and weights where appropriate

Jump and land drills

Agility drills

Straight line jogging

Swimming (light-kick)

Road bike

Straight line running at 3 months

Progressing to sport specific running and agility (progressively sequenced) – running forwards, sideways, backwards, sprinting, jumping, hopping, changing directions, kicking

Phase 4 6-12 months Return to sport High-level sport specific strengthening as required

Progressive return to sport e.g. restricted training, unrestricted training, match play, competitive match play

Adapted from Brukner et Khan 2006

Common Problems for Rehabilitation

Common Problems for Rehabilitation

Combined injuries Patella problems Low back pain Lower limb stiffness Collagen differences

Combined injuries Patella problems Low back pain Lower limb stiffness Collagen differences

ConsiderationsConsiderations

Contributors to initial injury quadriceps dominance leg dominance core dysfunction functional risk position

Train controlled body motions, especially deceleration and pivoting manoeuvres

Train landing with increased flexion at knee and hip

Contributors to initial injury quadriceps dominance leg dominance core dysfunction functional risk position

Train controlled body motions, especially deceleration and pivoting manoeuvres

Train landing with increased flexion at knee and hip