Overall Goals:
Return the athlete to sports no sooner than 10 months and to make the athlete a better, safer athlete to prevent future injuries. Will take athlete slower through the rehabilitation process due to revision surgery.
Immediate Postoperative: Day 1-7
Goals: Start PT immediately after surgery, unless advised otherwise.
- Protect the graft,
- Reduce pain and swelling
- Maintain passive knee extension throughout entire process
- Start ankle pumps, quadriceps isometrics, quadriceps activation exercises
- Start ROM
- Start patellar mobilizations – superior/inferior, medial/lateral
- TENS/NMES
- Ice, Elevation
- WBAT/PWB/NWB – dependent on surgery; use knee immobilizer while ambulating.
- Knee immobilizer while sleeping for 1st 6 weeks or until knee extension is maintained.
- Crutches for stability – can wean off crutches when stable
Early Postoperative: Week 1-4
Goals:
- WBAT – wean off of crutches when quadriceps function is strong enough and when patient feels comfortable enough while ambulating
- Continue knee immobilizer while ambulating and at night for 6 weeks total to prevent extension lag
- Maintain knee extension throughout – contact surgeon if any knee extension deficits
- ROM – knee flexion should be at 90 degrees by 2 weeks postop – Contact surgeon if significant deficit in knee flexion.
- Continue quadriceps activation
- Start stationary bike with no resistance as soon as tolerable
- Decrease swelling – Ice, elevation, compression wrapping (TED hose stocking should be worn for 2 weeks postop)
- Continue patellar mobilization
- TENS/NMES
Postoperative: Weeks 4-16
Goals:
- Patient should be off all assistive devices while ambulating
- Knee immobilizer at night until week 6 or until they can maintain full knee extension
- No open chain exercises until month 5 postop
- ROM – should be full ROM equivalent to opposite knee by week 6. If not achieved, notify surgeon and see patient more often to push their ROM until full motion is obtained.
- Continue quadriceps strengthening
- Start proprioceptive exercises, core
- Stationary bike – increase time and add resistance
- Elliptical can be added when patient tolerates
- Swimming – only after incisions are completely healed. Keep knee locked straight while swimming, No treading water and no butterfly kicks (too much rotation on graft).
Postoperative: 4 months to 6 months
Goals:
- Continue to push quadriceps strengthening
- Proprioceptive exercises
- Core
- Hip girdle strengthening
- Start light jogging with treadmill and slight incline – Begin at earliest 5 months (this is different from primary ACL Reconstructions) and when quadriceps girth is 50% of opposite thigh.
- Progress from jog to run when patient tolerates – No pivoting
- May begin open chain exercises at month 6.
- Can start light jumping at month 6.
Postoperative: 6 months to 8 months
Goals:
- Start pivoting at 7-8 months only if quadricep girth is 75% of the opposite thigh
- Continue increased conditioning
- Start single leg jumping as long as their quadriceps girth is improving and patient shows ability to protect graft.
- Continue proprioceptive exercises
Postoperative: 10 months to 12 months:
Goals: Return the athlete to sport
- Main criteria for patient to be cleared for sports will be quadriceps girth 90-100% equal to opposite thigh
- No imbalance on single legged squats on either knee
- Single leg hop progression test – patient demonstrating equal on each side.