Knee
VKB Recovery
An anterior cruciate ligament (ACL) rupture is a very common injury, especially among athletes. In our first blog post on "Rehab and Prevention of the Anterior Cruciate Ligament," we dive a bit into the anatomy of the knee and its structures. In our second blog post on this topic, we take a deeper look at the incidence, costs, and consequences of an ACL rupture. At the same time, the risk factors and mechanisms of injury are described in greater detail.
In this blog post, we want to shift the focus to the treatment and rehabilitation after an injury to the anterior cruciate ligament. The treatment protocols for isolated ACL injuries and combined injuries with the menisci or collateral ligaments are very similar. However, we are assuming an isolated ACL injury here.
Following the injury, athletes generally have three options. The best path to choose is carefully weighed and discussed with the treating physician, based on the individual needs and performance demands of the athlete:
Immediate surgery
Conservative treatment
Initial conservative treatment with surgical reconstruction if needed
The literature recommends that athletes who wish to return to high-risk sports undergo surgery with a reconstruction of the torn cruciate ligament.
Successful ACL rehabilitation, both after reconstruction and without surgical intervention, is a demanding and long-term challenge that requires a lot of patience and intensive outpatient therapy. In the best-case scenario, successful surgery is merely the foundation of an optimal recovery process. Without rehabilitation, however, a return to sports is unthinkable.
During wound healing and the entire rehabilitation process, several physiotherapeutic goals are pursued:
Graft-bone healing of the implant
(Recapillarization of the cruciate ligament)
Pain relief & swelling reduction
Maintenance (and restoration) of mobility, both tibio-femoral and patello-femoral
Restoration of proprioception and strength
Freedom from pain during everyday activities
Progression toward high performance in the respective sport
Optimal ACL rehabilitation must always be tailored individually to the patient, the acute nature of the injury, and the athlete's personal goals, as every body responds differently to such an intervention.
In addition to optimal rehabilitation, clear and comprehensive patient education is, of course, essential.
ACL Rehabilitation
Optimal ACL rehabilitation starts directly after the trauma with pre-operative rehabilitation. The goal of this phase is to bring the baseline level of the patient and the injured structure to the highest possible level before surgery. This will significantly impact the recovery process post-surgery. During this phase, great emphasis is placed on the extension capacity and joint mobility of the knee, but the power and strength of the quadriceps muscle are also of massive importance. Specifically, the patient should be able to actively engage the vastus medialis, which should be targeted and actively promoted through exercises.
Quadriceps strengthening before surgery is extremely critical. Studies have shown that a 20% deficit in quadriceps strength prior to surgery can lead to a significant deficit in quadriceps power for up to 2 years afterward [1].
The second phase of rehabilitation begins immediately after surgery. During this time, swelling and pain take center stage. Simultaneously, we work on activating the muscles, as they need to regain active control of the knee as quickly as possible. Once the knee can be actively stabilized during everyday movements and a normal gait is restored, underarm crutches can usually be phased out. Our physiotherapists at BodyLab are happy to advise you personally and individually.
From this point forward, it is all about controlled and adequate progressive overload on the knee, as well as regaining full range of motion. The focus is on the mobility and coordination of the lower extremities. Care should be taken that, although the affected leg is the main focus, both legs are always involved in the training. The musculature and coordination of the unaffected leg also regress during the immobilization period. Until full weight-bearing is achieved, underarm crutches may occasionally be used as an aid.
Achieving full weight-bearing in daily life is a major milestone in your rehabilitation journey! However, there is still a significant deficit in strength, coordination, endurance, and load tolerance. Therefore, the fourth phase continues to focus on strengthening and coordination. This is now done with heavier weights and increasingly sports-specific movements.
The final phase is all about sports-specific conditioning and full load tolerance in sports involving physical contact and high-risk movements. Here, athletes will train primarily on a neuromuscular level. This includes, among other things, plyometric exercises, maximum strength, and explosive power. High weights and rapid movements are utilized. A solid foundation is an absolute must by this point, otherwise the structures will not withstand the strain.
Conclusion
An injury to the anterior cruciate ligament is a serious injury that can be treated in various ways. Whether conservative or surgical, subsequent rehabilitation spanning several months is absolutely essential. A versatile and customized therapy supports the body's natural healing process and helps you regain full daily functionality. The phases mentioned above are guidelines and should not be viewed as a rigid protocol. Through consistent rehabilitation and disciplined training, 83% of elite athletes return to their sport after ACL reconstruction, competing in their first match within 6 to 13 months [3].
Whenever you need us, we are here for you!
Your BodyLab Team, your specialists for post-ACL surgery rehab
Osteopathy and Physiotherapy | Rehabilitation and Training
Zurich Altstetten
References
Nicky van Melick, Robert E H van Cingel, Frans Brooijmans….2016 Review
[2] Post-treatment protocol and Return to Sports after cruciate ligament surgery – Vavken, Sadoghi, Valderrabano, Pagenstert
C. H. Lai, C. L. Ardern, J. A. Feller, and K. E. Webster
Br. J. Sports Med., vol. 52, no. 2, pp. 128–138, 2018.
Header Image Credit
No machine-readable author provided. Lucarm84 assumed (based on copyright claims)., Legamenti crociati, designated as public domain, details on Wikimedia Commons
