ACL Rehab and ACL Physical Therapy Charlottesville VA

Rehabilitation following an ACL repair is necessary for complete recovery and to reduce the risk for an injury recurrence. The process is long and arduous, but the goal is to get each patient back into shape for all of the demands they will face both on and off the field.

ACL Graft Selection Considerations

There are a few things that can affect how your acl physical therapy will progress. The first thing to be aware of is where the tissue graft for the ACL comes from. Graft selection is surgeon dependent and they should advise you of which graft they hope to use prior to surgery. An autograft is a repair that uses a piece of tissue from the patient receiving the surgery. This tissue usually comes from the patellar tendon, quad tendon, or hamstring tendon. An allograft comes from a piece of tissue from a donor body.

• Considerations for hamstring tendon autograft: Delays ability to strengthen hamstrings for about 12 weeks
• Considerations for allografts: Increased time to revascularization: Time on crutches generally increases
  

Concurrent Injury Considerations

Other considerations following surgery are given if there was a secondary injury to a meniscus when the injury occurred. Depending on the type of injury to the meniscus, the surgeon may decide to do a menisectomy (removal) or meniscal repair during the ACL surgery. This can have an impact on the rehabilitation plan. 

• Considerations with meniscal repairs: Use of crutches with weight bearing restrictions for 6 weeks
• Considerations following menisectomy: Likely no impact on rehabilitation for the ACL

ACL Physical Therapy Repair Protocol: Weeks 1-6 ACL Rehab Exercises

Generally, the first few weeks of rehabilitation include protecting the graft and controlling inflammation, mobility exercises to restore range of motion, and promote muscle activation throughout the quad muscles. It is crucial to follow a home program dedicated to improving range of motion during this phase. Movement will promote increases in motion, reduction in swelling and stiffness, and can also help with relieving pain and discomfort. 



The other goal of this time period is to improve muscle activation throughout the quads and other muscles surrounding the knee joint. The sooner muscle activation and quad control improves, the sooner crutches can be removed for ambulation (except for surgeries with a meniscus repair). Sometimes if the quads are not activating as expected (which can happen due to nerve blocks used during surgery or pain), electrical stimulation is used to promote a contraction within the muscle. 

Benchmarks: Full extension ROM; reduced swelling, reduced pain, no extension lag during straight leg raise

Range of motion will continue to be progressed during this phase of rehab following an ACL repair. The goal will be to attain full flexion range of motion, and to continue working on extension as well, although most patients will have achieved full extension ROM by this point. 

Strengthening will progress in this phase with emphasis on weight bearing exercises including squats, lunges, and step-ups. Special attention will be paid to the quads during strengthening, as these muscles are usually affected most following the surgery. Single leg exercises are likely to be performed as there will be a deficit, but it is important to work the other side at home when possible as there is research that there can be carry over to the affected side when exercising the uninvolved side.