Sorry, I'm back. Not sure where I was but time gets away from me! I thought I would start a series of posts following the progress of a patient who recently underwent anterior cruciate ligament (ACL) reconstruction surgery. I plan to do this with weekly posts to provide you with inside look of what ACL rehab is like at our facility.
The ACL is one of four primary stabilizing ligaments within the knee joint. It is definitely the most often injured ligament in the knee and thus something that we see hundreds of per year at the Sports Medicine Center.
The two most common graft types are patellar tendon and hamstring tendon autografts (taken from the individual's own body). This particular patient received a patellar tendon autograft to replace the damaged ACL after an attempted hamstring graft was aborted due to poor condition of the hamstring tendon.
I first saw this patient one day after surgery (post-op day one). That may seem a bit soon, but I really like this approach and have found patients to do very well when they get an early start on their rehabilitation. The earlier patients start to bend their knee and work their quadriceps muscle the quicker they progress to normal walking. In most cases, the physical therapy visit one day post-op is fairly minimal. I help the patient bend and straighten their knee some and instruct them on how they can do this at home. We also initiate quad sets to start to “waken” that muscle from the deep sleep of anesthetic. If the patient does well with quad sets, straight leg raises are started. We then cover some simple weight shifting and proper use of crutches for walking and putting some weight on the injured leg.
Yes, most ACL reconstructions are weightbearing as tolerated (WBAT) this soon after surgery and do quite well with this. Lastly we finish with ice and elevation to help reduce the edema from surgery. The patient will be icing frequently each day during the first week while at home.
Next week, I'll summarize the post-op one week visit and see how our patient is progressing. I'll also discuss how we organize rehab to protect the ACL graft.