Chapter 13 Rehabilitation of Primary and Revision Anterior Cruciate Ligament Reconstructions
CLINICAL CONCEPTS
The two anterior cruciate ligament (ACL) postoperative rehabilitation protocols described in this chapter consist of a careful incorporation of exercise concepts supported by the scientific data presented in Chapter 12, Scientific Basis of Rehabilitation after Anterior Cruciate Ligament Autogenous Reconstruction. The protocols are evaluation-based; that is, progression through the program is based on continual evaluation using the principles of anatomy, physiology, biomechanics, and surgery 2–5,7,14–17 and understanding that the overall goals of the reconstruction and rehabilitation are to




Specific criteria are evaluated throughout both rehabilitation programs to determine whether the patient is ready to progress from one phase to the next. Both protocols incorporate a home self- management program, along with an estimated number of formal physical therapy visits (Table 13-1). For most patients, 11 to 21 postoperative visits are expected to produce a desirable result. A few more supervised sessions may be required between the 6th and the 12th postoperative month for patients who undergo advanced training to return to strenuous activities. A specific neuromuscular-retraining program (Sportsmetrics) is advocated for all patients returning to high-risk activities, discussed in Chapter 19, Decreasing the Risk of Anterior Cruciate Ligament Injuries in Female Athletes. For all patients, the following signs are continually monitored postoperatively: joint swelling, pain, gait pattern, knee moion, patellar mobility, muscle strength, flexibility, and AP displacement. Any individual who experiences difficulty progressing through the protocol or who develops a complication is expected to require additional supervision in the formal clinic setting.
TABLE 13-1 Estimated Supervised Physical Therapy Visits after Anterior Cruciate Ligament Reconstruction

REHABILITATION PROTOCOL FOR PRIMARY ACL B-PT-B AUTOGENOUS RECONSTRUCTION: EARLY RETURN TO STRENUOUS ACTIVITIES
Modalities
TABLE 13-2 Cincinnati Sportsmedicine and Orthopaedic Center Rehabilitation Protocol for Primary Anterior Cruciate Ligament Reconstruction: Early Return to Strenuous Activities












Postoperative Bracing
Range of Knee Motion
Patellar mobilization: all four planes, done with motion exercises.
Partial weight-bearing immediately, full by 3–4 wk.
Flexibility: Hamstring, gastrocnemius-soleus, quadriceps, iliotibial band.
Strengthening
Balance, Proprioception
Running, Agility
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