Anterior Cruciate Ligament Reconstruction and Postoperative Rehabilitation
 Introducion .

The torn anterior cruciate ligament will be reconstructed with either a part of the patellar tendon or with the hamstring tendons. The patient will be in hospital for one or two nights, and the drip will be removed the day after the operation.

The physiotherapist, Pauline Versfeld, will make daily visits from the day of the operation. The rehabilitation exercises may seen simple and easy, but it is of the utmost importance that they should be done regularly and in the correct way to ensure a quick and thorough recovery.

The bandage around the knee will be removed before the patient is discharged from the hospital, and the wound will be covered with a small plaster strip. The plaster may be removed one week after the operation, by which time the wound should have healed well enough to allow baths or showers. The sutures are soluble and beneath the skin, and do not have to be removed.

Postoperative programme

It is important to follow a specific postoperative programme after ligament reconstruction. The aim of the programme is to regain full mobility in the knee, without damaging the newly reconstructed ligament. It is essential to remember that it will take approximately eight months for the reconstructed ligament to become strong enough for sporting activities. It is very important not to put abnormal load on the ligament during these first eight months after the operation.

The following routine is an outline of a basic exercise programme. Depending on the exact nature of the surgery to the joint, the programme may be changed to suit individual needs.

Week 1
Week 2 to 3
Week 4 to 6
Week 6 to 12
Week 12 to 20
Week 20 to 35
After 8 to 12 Months

Week 1

IMPORTANT: There should be no extension against resistance in the last 40 degrees of knee extension during the first four months after the operation.

Full active range of movement with the heel resting on the floor or the bed.
Isometric quadriceps contraction with the knee bent 30 degrees.
Active knee extension in the range of 90 degrees to 40 degrees extension with foot turned outwards.
Active knee flexion from full extension to 90 degrees of flexion.
Full passive extension with a pillow under the heel.
Walk on the toe of the operated leg with the knee bent, preferably on crutches for the first few weeks.
Week 2 to 3

It is important to get full passive extension of the knee, i.e. to straighten the leg completely.

Continue with the first week’s programme. Start exercising the hamstring and quadriceps muscles against resistance. Quadriceps resistance should only be in the range of 90 degrees to 40 degrees of extension, with the foot turned outwards.
Hip exercises: Stand on healthy leg and move the hip in all directions.
Knee squats in a flexed position from 30 degrees to 40 degrees of flexion.
Indoor cycling: Seat low with knee not extending beyond 30 degrees of flexion.
Hamstring flexion against resistance.
Week 4 to 6

Continue with all the previous exercises.
If a pool is available, start with water exercises.
Walk normally, making sure that the knee straightens completely while walking.
Week 6 to 12

REMEMBER: The reconstructed ligament will need at least six months to regain adequate strength. The ligament is at its weakest approximately six to eight weeks after the operation.

Be patient! Continue with the previous exercises.
If a pool is available, start swimming – crawl, do not swim breast-stroke.
Week 12 to 20

Start jogging slowly on the level.
Start outside cycling, even against resistance, but take care to sit while pedaling.
Week 20 to 35

The patient is now ready to exercise in the gym – both the hamstring and the quadriceps can be exercised to maximum strength. At this stage, and not earlier, biokinetics would be very helpful.
After 8 to 12 Months

The muscles should now be at maximum strength. If the stability is adequate, sporting activities may be resumed. It is important that the patient shoud keep the muscle strength at maximum for the rest of the his or her sporting career.