ACL Rehabilitation
ACL rehabilitation patient, Marcus, runs for the first time after undergoing ACL and meniscus tear surgery. [Name and video are used with written permission from the patient.]
ACL injuries are most common during sports that require sudden stops, pivots, or changes in direction, such as football, basketball, tennis, volleyball, and soccer. It affects over 250,000 Americans each year.
Today, we have an interview with physical therapist, Bobby, on ACL injury and rehabilitation.
What is an ACL injury? How does it happen?
Bobby: The ACL, anterior cruciate ligament, is a primary ligament that is located in the knee joint. It originates at the anterior base of the tibia and extends posterior to the femur. The ACL is a major ligament in the center of the knee, a band of tissues that holds the bones together within the knee and keeps the knee stable.
ACL injuries commonly occur in two ways, contact and non contact injuries. Contact injuries occur when a force overcomes the tensile strength of the ACL – such as a helmet to the knee during a football game. Non-contact injuries occur during a sudden change in movement (like a fast pivot or cut) that asks the ACL to do too much. Non-contact injuries are more common in women than men.
What are symptoms of an ACL injury?
Bobby: Symptoms include:
Pain
Audible pop in the knee
Difficulty standing and putting pressure on the injured leg
Swelling within 24 hours
Difficulty walking
Limited Range of Motion
How do you diagnose an ACL injury?
Bobby: At the time of injury, if present, a physician may perform a Lachman’s test to assess the integrity of the ACL. If a positive test is shown, an MRI will be done to confirm the diagnosis.
What does rehabilitation for an ACL injury involve? How long is rehabilitation?
Bobby: ACL rehabilitation can occur in two scenarios – operative and non-operative. Under an orthopedic or sports physician’s care, the doctor will determine what option is best for the patient. For an athlete, the operative route is recommend. Post-operative ACL rehab normally takes 9 to 16 months depending on the goals of the patient.
A typical outline of ACL rehabilitation includes:
Phase 1 Goals: [Surgery to 4 weeks post-surgery] improve range of motion, decrease swelling, regain leg muscle control, and regain full extension of the knee.
Phase 2 Goals: [4 weeks to 11 weeks after surgery] restore proper body alignment and control with basic movements like walking, squats, or balancing and build leg and core strength.
Phase 3 Goals: [12 weeks to 16-20 weeks after surgery] develop good movement control with more complex movements, e.g. a lunge requiring rotation. It is important in this phase to improve movement control and eliminate fear when cutting or pivoting with the rehabilitated knee. The patient also works on single leg impacts and pushing off while changing direction.
Phase 4 Goals: [16-20 weeks to 24-32 weeks after surgery] Athlete transitions from intense cutting and pivoting in a controlled environment to an environment that more closely replicates the sport. This would involve the patient returning to team practices with a gradual decrease on limits.
Phase 5 Goals:[begins 24-32 weeks after surgery] Before an athlete returns to the sport, the physical therapist has the athlete complete a series of progressive tests to determine when the athlete can safely return to activity and sports.
What is your approach to ACL rehabilitation? Why do you specialize in sports rehabilitation?
Bobby: My approach to ACL rehab is to improve range of motion and control swelling/edema early on by the six-week mark. We also try to establish good contraction of the quadricep muscle early on to help promote good knee extension and strength. For the next several weeks, it’s all about getting the knee strong and progressively loading the knee joint to handle a lot of stress. By the 3-4 month mark, we work on activities such as running and jumping to establish good mechanics. Months 7-12 ,we address sport-specific activities and work so that the patient is able to return to their sport. The patient must pass a variety of tests in order be able to return to sport.
As a former athlete who has undergone rehabilitation for injuries on several occasions, it brings me great joy to see former athletes and non-athletes return to the activities they love. Most rehabs take a lot of time and it’s a fun to see how patients progress over the course of weeks and months. During that time, I get to build great relationships that tend to go beyond the rehab setting. Everyone loves a good comeback story and I’m humbled to be apart of the journey.
