What Happens After an ACL Tear Surgery?

Following an ACL tear, many patients find the only way to regain full strength and function is ACL surgery. What happens after an ACL tear surgery and what does recovery look like?

David P. Whitaker, MSPT, clinic manager and certified physical therapist at Ability Rehabilitation’s Lake Mary / Heathrow location, in Lake Mary/Heathrow, understands exactly what it takes to help patients get back to 100% after ACL surgery.

“When we get someone who’s been referred to us for an ACL rehabilitation after surgery, the first thing we do is find out who their physician was,” says David.

“Each physician has a specific protocol depending on the type of graft they use. But a typical ACL protocol will involve, first of all, controlling the patient’s edema, and getting their pain level under control.”

Reducing ACL Pain and Swelling

Indeed, the first step toward a successful ACL rehabilitation begins immediately after surgery and focuses on alleviating the pain and swelling common after ACL tear reconstruction procedures. Pain and swelling make it very difficult to activate the muscles around the knee, especially the quadriceps muscle, limiting range of motion, and keeping joints bent and stiff.

It’s crucial to deal with pain and swelling first following a torn ACL, to free up knee muscles and begin to restoration of range of motion. To help reduce pain and swelling after surgery, a physical therapist may recommend:

  • Ice and compression wraps
  • Keeping the leg elevated as much as possible
  • Ankle pumps
  • Electrical stimulation
  • Avoiding overexertion and load on the knee

Establishing Full Knee Extension Following an ACL Injury

During the first week after surgery, when the pain and swelling have been brought under control, patients are usually ready for the next critical step in the ACL rehab process: getting back full extension of the knee.

Ability Rehabilitation ACL“We usually start with early range of motion emphasizing quality extension,” says Whitaker. “And then gradually get the patient’s flexion range of motion going, based on how their swelling and pain are doing.”

Surgeons and physical therapists will usually give patients a set of simple gentle exercises to do at home, in order to keep the knee joint as mobile and fluid as possible during this early, yet critical part of the recovery phase. They may also recommend gently riding a stationary bike for short periods of time to help this process along.

Loss of mobility in the knee is a frequent complication after ACL surgery, especially with regard to knee extension. Patients who experience pain and swelling will prefer to keep their knee slightly bent, as this is the most comfortable position for them to be in; however, keeping the knee in that position too long can allow the buildup of scar tissue, leading to arthrofibrosis and eventually cause arthritis, resulting in an even greater loss of knee mobility later on. Limping, weak thigh muscles, and pain in the front of the knee, are symptoms that patients are losing extension in their knee.

It’s imperative that patients work on knee extension from the get-go after surgery, to keep the knee joints as fluid as possible. Because once the knee joint tightens up after surgery, it will be that much harder to restore its range of motion afterwards.

Restoring Flexion of the Knee Following a Torn ACL

Extension and flexion of the knee go hand-in-hand, so once extension is restored, reestablishing knee flexion will be the next priority.

“After extension, we’ll go ahead and start some gentle exercise to start recruitment of the quadricep muscle, as typically it atrophies some after the surgery from the swelling,” says Whitaker. “We’ll do some light quad exercises, get some hamstring activation, gentle stretching, as the patient is able to.”

After working on the muscles associated with knee extension, patients will need to balance their efforts on the flexion side, to avoid getting stiff when moving in the other direction. They can achieve this by performing short spurts of gentle range of motion exercises, both flexing and extending the knee.

Sustain Patellar Mobility After an ACL Reconstruction

A fluid and free-moving patella (kneecap) is essential in order to be able to fully flex and extend the knee. Pain, swelling and the buildup of scar tissue can impede the movement of the kneecap, particularly if a graft of the patella tendon was used as part of the ACL surgery. Mobilizing the soft tissues around the patella can greatly improve chances of attaining full knee flexion and extension.

Walking After an ACL Surgery

Healing times will vary from one person to the next, depending on age, medical history and lifestyle. Typically around 3-4 weeks after surgery, physical therapists will have patients work on shifting weight from one foot to the other (called ambulation). From there, patients progress to walking without support and functional strengthening of the knee.

“We’ll start improving the patient’s gait-walking pattern as tolerated, and based on their protocol,” Whitaker says. “And from there, we’ll go into a functional closed and open chain strengthening protocol.”

Somewhere around 6-8 weeks after surgery, physical therapists will have patients perform more dynamic agility and strengthening exercises. Beginning with shorter, slower strides and then increasing the speed and length of the stride as patients feel comfortable and in control of their movement. Some examples of dynamic drills include:

  • Skipping forwards and backwards
  • Skipping sideways
  • Back pedalling
  • Quick steps forward and stopping
  • Fast stepping in place

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How Long Will ACL Rehabilitation Last?

Recovering from ACL surgery is a gradual process that can take anywhere from six to 12 months to fully realize. The success of any ACL rehabilitation program lies largely on the vigilance and determination of the patient, and the experience and care of their surgeon and physical therapist.

“Usually a typical ACL patient will be here (at the clinic) for a good two to three months for the initial phases,” David says. “Most doctors will let the patient start sports at the nine to twelve month mark, where they may need some more agility training once they’re cleared for that.”

Diligently following the guidelines and advice of surgeons and physical therapists will pay great dividends and help minimize ACL rehabilitation recovery time.

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