ACL Post-Surgical Recovery

 - By Dr Erin Caplice 

A successful recovery after ACL surgery starts with early knee rehabilitation, which aims to achieve various goals to ensure adequate healing of your knee and allow you return to your normal activities. 

Goal 1: Reduce Pain and Swelling

Pain and swelling is common and to be expected following surgery. In order to manage this, recommendations include:

• Applying ice to the surgical area to reduce inflammation.
• Keeping your leg elevated to minimize swelling.
• Taking medication as prescribed by your doctor to alleviate pain.
• Consider lymphatic massage to manage swelling, as this can affect range of motion and pain levels.

Goal 2: Restoring Range of Motion

Regaining your knee's range of motion is crucial for optimal function down the road. This includes: 

• Full Extension: The primary goal is to achieve 0 degrees of extension, or a completely straight leg as soon as possible. This is in order to achieve normal walking patterns later on. 
• Gradual Flexion: Slowly work on bending your knee, following your surgeon's restrictions. Different surgical procedures will have different guidelines on degrees of flexion permitted early on. 
• Passive and Active Exercises: Utilize a strap or towel to assist with both passive and active flexion and extension movements of the knee.
• Low-Intensity Extension Exercises: Include exercises like prone hangs and heel props initially.
• Patellar Mobilization: If you had a patellar tendon graft, specific techniques may be used to mobilize the patella to improve knee mobility.

Goal 3: Protect The Surgical Site 

Your surgical site requires careful protection in order to ensure proper healing and to prevent infection: 

• Use crutches for support, and gradually reduce reliance on them as directed by your surgeon.
• Wearing a knee brace can provide stability early on and prevent excessive strain.
• Keep the surgical area covered and clean to prevent infection.

Goal 4: Quadriceps Activation

Maintaining muscle strength is essential to reduce atrophy and loss of function:

• Isometric Contractions: Practice quad sets early on to activate your quadriceps muscles and improve knee stability.

Goal 5: Weight-Bearing Progression and Gait Training

The gradual introduction back to complete weight-bearing varies based on your surgery type. Regaining normal walking patterns is a crucial part of recovery: 

• Start with using crutches and a brace when walking. This is to prevent compensatory movements. 
• Follow your surgeon's guidelines for a safe transition.

Goal 6: Manage Scar Tissue 

Preventing excessive scar tissue is essential:

• Scar tissue mobilization techniques can help reduce adhesions and promote proper healing.
• Excess scar tissue can impact range of motion in the knee during recovery. 

Goal 7: Neuromuscular Control

Neuromuscular control exercises can help to enhance joint stability and reduce the risk of injury after surgery: 

• Exercise that focus on improving balance and the body’s awareness of its position will help to improve joint stability.

Goal 8: Education on Knee Protection

It is important that those who have undergone ACL surgery know how to protect their healing knee:

• Discuss with your healthcare provider what activities to avoid while your graft is healing. Early on in recovery activities such such as kicking and pivoting are not recommended. 
• Follow your surgeon and physical therapist’s instructions regarding brace usage during the early weeks post-surgery.

Goal 9: Psychological Support

Increasing one’s confidence and motivation is crucial while going through a post-surgical rehab plan:

• Seek emotional support and encouragement to maintain a positive mindset throughout your recovery journey.

Early knee rehabilitation after ACL surgery is an extensive process designed to help you regain strength, mobility, and function in your knee. By addressing these essential goals, you'll pave the way for a successful recovery and get back to activities you love to do. A typical treatment session with your physical therapist after ACL surgery will address all of the goals listed above. Your physical therapist will achieve these goals using a combination of rehabilitation exercises, manual therapy and modalities, tailored to your specific needs.  Always consult with your healthcare team and physical therapist for guidance customized to your specific needs.