ACL - Phase One
After listening to our last Five Minute Friday episode, ACL Tears, The Basics!, one of our patients wanted to know what to expect after a surgical ACL repair.
As discussed in that episode, ACL tears are commonly repaired with graft surgery - taking the tissue of another tendon in the body and sewing it to the damaged ACL tendon.
Like any other procedure, swelling is to be expected. Also, it should be no surprise that you will have difficulty with knee extension (straightening and bending your knee).
Something that may come as a surprise is what's called an extensor lag - the inability to contract your quadriceps. This means you’ll have difficulty lifting your leg. But this is very common and you will regain contraction in about a week or two after surgery. This is something that will be worked on in physical therapy as well.
Will you need crutches or a brace after surgery?
You will use crutches for about 1 - 2 weeks after surgery as full weight bearing is increased throughout your rehab. ACL protocols vary but patients usually begin walking without crutches anywhere around day three to week two. Usually you will go from two crutches to one and eventually phasing them out completely.
Whether or not you are given a brace after surgery is dependent on your surgeon. Typically, if given a brace after surgery, you will have a bigger, bulkier one - one that is locked in place and only unlocked at physical therapy. As you progress through your rehab, a smaller unlocked brace will be given to you.
What are the most important aspects of rehab?
Activating your quadriceps and regaining your knee extension are very important aspects of ACL rehab. This is because knee extension (bending and straightening the knee) influences your gait and ability to walk, climb stairs, etc.
The number one thing that a patient needs to gain after ACL reconstruction surgery is quadriceps strength. Without it you will not be able to progress to higher levels of activity and your mobility will be limited.
Knee range of motion is also very important…
Full knee range of motion is also an important aspect of a successful rehab. After surgery you will have a very limited range of motion. The goal is for you to have your full range of motion back around the 6 - 8 week mark. During week 1 - 2 you and your physical therapist will work on getting you to a 90° angle. Week two - six you will progressively work on gaining a full range of motion (140°).
Thanks for reading! Stay tuned for more information in the coming weeks.
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Dr. Tony Tanzi: Physical Therapist, Triathlete, Runner, Performance Coach