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Approximately 200,000 anterior cruciate ligament (ACL) injuries are recorded annually in the United States and half of those patients require reconstructive surgery. An ACL is a major ligament of the knee – connecting the femur and the tibia. ACL tears are most common among athletes in high-risk sports, such as football, basketball and soccer.

Following an ACL injury patients are examined by an orthopaedic surgeon to determine if surgery is required to repair the ligament. Most people who experience an ACL tear undergo surgery, but some are able to avoid surgery by going to physical therapy and modifying their physical activity. Whether a patient undergoes surgery or doesn’t, physical therapy is an important part of recovery.

The role of a physical therapist is vital if a patient wishes to restore knee function.  Physical therapists are responsible for helping patients reduce swelling, restore mobility, regain range of motion, and improve overall strength of the quadriceps and hamstring muscles.

Preparation before Surgery

Some orthopaedic surgeons recommend patients see a physical therapist prior to surgery to help with swelling and overall leg strength. A lot of patients experience “quadriceps lag” after an ACL tear. This is noted when patients try to lift their straightened leg but can’t do it without having a slight bend in the knee. Research indicates that alleviating this condition before surgery results in better outcomes. If patients want to overcome quadriceps lag, a therapist’s help is necessary.

Rehabilitation after Surgery

The first two weeks after surgery are spent keeping the wound clean and regaining the ability to straighten the knee. Ice is regularly applied to reduce swelling and to help with pain. Most patients are required to wear a brace and some surgeons prescribe a machine that moves a patient’s knee through ranges of motion. However after the first few weeks a physical therapist is needed to help patients go through a variety of exercises.

Physical therapists typically give patients a list of exercises that they can do at home. These exercises usually focus on regaining movement of the knee. Therapists also like to use electrical stimulation to help strengthen the quadriceps muscle and aid with knee extension.

One of the main goals during the first month after surgery is to place weight on the knee. This is achieved slowly and with the help of a physical therapist. Therapists guide patients through a number of weight-bearing and non-weight-bearing exercises to accomplish this goal. The second and third months after surgery are spent walking without crutches and making attempts to regain a normal gait. Once again, a therapist should be by a patient’s side every step of the way.

After four months a therapist will start planning more rigorous exercises as long as the patient is progressing as scheduled. Athletes who wish to recover so they can play again will be put through a series of exercises that center around balance, running and jumping. Most athletes return to their sport one year after the injury occurred, but an ACL injury should never be rushed. Therapists recommend returning to sports and regular activity when pain and swelling is gone. Feelings of instability when cutting, jumping and landing should also be gone and quadriceps strength is at least 90 percent back to normal.

Patients need to work with a physical therapist that has experience in rehabilitating ACL injuries. Typically your orthopaedic surgeon can recommend a physical therapy facility that is more than qualified to help you recover.

Paul Roettges, MD
A member of the American Academy of Orthopaedic Surgeons and the American Association of Knee and Hip Surgeries, Dr. Roettges performs hip and knee replacements as well as complex unresolved hip and knee pain.

 

Sina Kasraeian, MD 
Board Certified by the American Board of Orthopaedic Surgery and has extensive training in arthroscopy and sports medicine reconstructive procedures.