| Injuries affecting the knee joint can cause | | | | average time for rehabilitation after ACL |
| considerable disability and time off sport. They are | | | | reconstruction to return to sport has been reduced |
| common in all sports that require twisting movements | | | | from 12 months to six to nine months. |
| and sudden changes in direction. It is important to | | | | Rehabilitation must commence from the time of |
| understand the role of the different ligaments and | | | | injury, not from the time of surgery, which may be |
| menisci in the knee joint in order to understand | | | | days or weeks later. The preoperative management |
| better the mechanisms of injury which will lead to | | | | aims to control swelling and restore full range of |
| form an appropriate rehabilitation programme. The | | | | movement and adequate strength. Walking, |
| knee injury of greatest concern to the athlete is the | | | | swimming and the use of a bike is incorporated |
| tear of the anterior cruciate ligament (ACL). The ACL | | | | during this phase. The progression of the |
| is a tough fibrous structure that attaches the shin | | | | post-operative programme depends on the patient's |
| bone (tibia) to the thigh bone (femur). This ligament | | | | determination, level of swelling and pain, and the |
| helps to stabilise the knee by preventing excessive | | | | progression of healing of the reconstructed ligament. |
| forward movement of the tibia on the femur. | | | | The second phase of the rehabilitation phase is to |
| Clinical Features | | | | control swelling, regain full knee extension, improve |
| Most ACL tears occur when the athlete is landing | | | | quadriceps strength, hamstring length and increase |
| from a jump or when running, suddenly side-stepping | | | | proprioceptive input. Normal walking pattern can be |
| or changing direction by decelerating. Occasionally, a | | | | achieved in this phase. |
| tear will occur as a result of another player falling | | | | Phase 3 aims to achieve full range of movement of |
| across the knee. It is often surprising to patients how | | | | the knee, strength of the quadriceps and hamstring |
| a relatively simple movement can result in a torn ACL. | | | | muscles, a full squat and the athlete may be able to |
| At the time of the injury, the athlete may report | | | | return to straight line jogging and running. Some |
| hearing a "pop" and that it feels like the knee was | | | | athletes progress rapidly in the post-operative phase, |
| being stretched apart. Most complete tears of the | | | | but full functional rehabilitation of the ACL may not |
| ACL are extremely painful, especially in the first few | | | | occur until 6-12 months post-operatively. Functional |
| minutes after injury. Athletes are initially unable to | | | | testing should be used to help assess readiness to |
| continue their activity. Tear of the ACL is usually | | | | return to sport. Functional tests include agility tests, |
| accompanied by the development of a haemarthrosis. | | | | the standing vertical jump and the "Heidon" hop. The |
| This may be visible as a large tense swelling of the | | | | patient performs the heidon hop by jumping as far as |
| knee joint within a few hours of the injury. | | | | possible using the uninjured leg, landing on the injured |
| Examination of the knee is also very typical. There is | | | | leg. Athletes with good function are able to land still. |
| often a loss of full extension of the knee and an | | | | Those with functional disability step further or take |
| inability of the athlete to weight-bear on the injured | | | | another small hop. Another way of testing function is |
| leg. Manual testing may reveal excessive forward | | | | by incorporating sport-specific drills in the rehabilitation |
| movement of the tibia on the femur. Once the | | | | programme; for example, running forwards, |
| athlete is diagnosed with an ACL injury, they may | | | | sideways, backwards, sprinting, jumping, hopping, |
| undergo surgery to reconstruct the torn ligament, or | | | | changing directions and then kicking. |
| rehabilitate the knee without surgery. | | | | Phase 4 of the rehabilitation programme includes |
| Functional Rehabilitation After ACL Reconstruction | | | | high-level sport-specific strengthening as required and |
| Management principles have changed dramatically in | | | | return to sport, progressing from restricted training |
| recent years, resulting in greatly accelerated | | | | to unrestricted training, and finally to match play. The |
| rehabilitation after ACL reconstruction. The traditional | | | | therapist must be careful on the progression of the |
| principle of complete immobilisation has been replaced | | | | rehabilitation exercises and on the timetable for |
| with protected immobilization with a resultant | | | | returning the athlete to their particular sport. An |
| dramatic decrease in stiffness and increase in range | | | | accelerated rehabilitation programme under a |
| of motion of the knee joint. This has allowed earlier | | | | controlled environment allows the athlete to return to |
| commencement of a strengthening programme and a | | | | sport sooner without increasing the risk of |
| rapid progression to functional exercises. Hence, the | | | | complications. |