We all know someone who have had some form of knee surgery. Common surgery types include arthroscopy for Ligament repairs following injury to the anterior cruciate ligament (ACL) and/or meniscal repairs, this is particularly common among athletes who play basketball, soccer, and rugby. Your ACL and menisci play important roles in supporting full mobility in your knee especially during highly physically-demanding sports, and require a thorough Physiotherapy rehabilitation program to ensure optimal function and prevention of re-injury.
Evidence suggests and we are firm believers that GOAL-based Physiotherapy rehabilitation is far more superior and effective than TIME- based Physiotherapy rehabilitation, however there must be an understanding of biological healing times of the knee during recovery.
There are generally 6 phases of rehabilitation following ACL reconstruction and/or meniscal repair, where the goals of each phase should be achieved before progression to the next phase. As Aspire physiotherapy we not only help with your rehabilitation we help clients through the various stages to ensure we achieve the absolute best outcome.
Phase 0: Pre-habilitation before surgery
There is strong evidence that demonstrates the benefits of a 5-week Physiotherapy program prior to knee surgery, with stronger and more improved function during recovery. Restoration of the knee to its optimal function with thorough prehabilitation prior to surgery will lead to a faster recovery.
Goals of Prehabilitation:
- Reduce acute swelling and regain free full range of motion
- Optimise knee muscular strength, function and stability
- Familiarise basic post-operative exercises
Phase 1: Recovery from surgery
Due to the acute trauma of surgery the knee needs some time to recover and rest, however basic gentle range of motion exercises involving knee flexion and extension and regular icing and elevation for the first 1-2 weeks are beneficial. Manual therapy from the Physiotherapist is indicated to maintain patella (knee cap) mobility.
Goals of Phase 1:
- Settle and minimise swelling
- Achieve full extension (straightening) range of the knee
- Establish quadriceps ‘firing’ and muscular control
Phase 2: Strength & neuromuscular control
The ACL graft progressively remodels into a ligament and during this, its strength and fatigability only increase to approximately 30% of a normal ACL around 3 months, followed by gradual strength increases in the subsequent 9 months.
Physiotherapy exercises can progress to body weight exercises followed by a gym-based program, however any resisted open-chain quadriceps exercises (e.g. leg extension machine) will be avoided to reduce strain to the new ACL. Exercises will target strengthening, balance and muscle coordination however presence of pain and/or swelling during or after exercises are symptoms that indicate the knee is not tolerative the workload and thus exercises will be adjusted accordingly.
Goals of Phase 2:
- Regain single leg balance and control
- Regain most of total muscle strength
- Perform a single leg squat with good technique and knee alignment
Phase 3: Proprioception & agility
As sufficient strength is achieved and the knee is free of swelling and pain during Phase 2, this next phase emphasises on a return to running, agility, jumping and hopping with the continuation of a gym-based strengthening and neuromuscular program. Our Physiotherapists will assist in ensuring correct technique during jumping, landing and pivoting tasks as this is imperative before progressing back to sport or any other previous activities, and preventing re-injury.
Goals of Phase 3:
- Achieve correct techniques during running and jumping tasks
- Successful progression through agility program
- Regain full strength and balance
Phase 4: Sport specific skills & return to sport
A highly individualised program of sports/activity specific drills will be commenced and integrated into the existing regime, with focus being on replicating the sporting/activity demands required. The knee should be stable and strong and this point and be demonstrating optimal neuromuscular patterns and biomechanics, as well as mental confidence from the individual to be ready to return to sport/work, etc.
Goals of Phase 4:
- Perfect jumping, landing and change of direction techniques
- Regain confidence with sports/activity specific drills and skills & eager to return
- Discussion of ACL re-injury prevention program is discussed and implemented and continued during participation in sport
Phase 5: Return to play & prevention of re-injury
The goals of Phase 5 must be adequately achieved before returning to any sports or proposed demanding work/social activities, and when deemed ready to return they may be advised to implement some modifications. Our Physiotherapists encourage individuals to play/participate within their level of confidence, as well as maintenance of training and skill work with adherence to our injury-prevention programs to improve performance and overall confidence.
Goals of Phase 5:
- Self-reported scoring on confidence of outcomes to return to play
- >90% quadriceps strength and hop symmetry
- Understanding of importance of continuous injury prevention programs while participating in their sport/activity
If you are planning an ACL reconstruction surgery and/or meniscal repair, or are conservatively managing your knee injury, book an appointment with one of our Physiotherapists to lead your post-operative rehabilitation in the right direction to achieve your goals!