The bending motion of our knee is a complex mechanism with a number of bones, muscles, ligaments and tendons at work. These multiple components of the knee joint are sometimes overworked or overstressed due to a sudden physical activity such as recreational sports which can cause the ACL injury. Patients with severe tear in the Anterior Cruciate Ligament (ACL) are recommended surgery as a treatment option. As the knee joint is important for mobility, it is advised that patients treated with surgery should opt for physiotherapy and exercise
Our knee is a hinge joint. It is supported on four sides by the lateral collateral (LCL), medial collateral (MCL), posterior collateral and the anterior collateral (ACL) ligament. An ACL injury occurs when the ligament is partially or completely torn because of the awkward landing of the knee joint. In most cases, an ACL injury is a complete tear or on rare occasions a partial one. The incidence of ACL injury has been noted more in women than men because of their physical structure.
ACL injury is surgically treated to reconstruct the torn ligament as it cannot be sutured (stitched) back. The torn ligament is reconstructed by adding a tissue graft at its place and growing it back. The growth procedure is very long and so rehabilitation through physiotherapy and exercise therapy is recommended. This is a generalised structure of the rehabilitation process as it varies for different patients depending upon the severity of the injury.
1. Acute phase
The acute phase includes containing the swelling and pain caused by the surgery. In this phase, no exercises are recommended, but your physiotherapist will ask you to constantly apply ice packs to the knee swelling and continue medication as directed by your surgeon. Patients are asked to use crutches or some other walking aid to avoid stressing the injured knee. The use of leg braces and the CPM (motion machine) is still argued upon by doctors.
2. Recovery phase
Within a week of surgery, range of motion exercises are suggested by the physiotherapist to extend the range of motion of the knee which was earlier reduced due to the injury. The exercises are more focused on the extension (straighten out) motion than flexion (bend in) motion as it is easier to achieve flexion. This phase lasts for one or two weeks depending upon the progress made by patients.
3. Strengthening phase
As full range of motion is achieved in the recovery phase, focus shifts from movement to strengthening of the joint. Physiotherapists concentrate on balance and proprioceptive exercises. Depending on the condition of the knee, some sport related activity is also started in this phase.
4. Activity phase
The activity phase emphasises on light sport activities like jogging, cycling and swimming. This sport activity phase last for about 12 weeks and then you could return to controlled physical activity.
Recovery from an ACL injury surgery could take months, so you need to be patient. For further reading on rehabilitation form ACL surgery refer Journal of Athletic Training.