ACL tear? Post-operative success starts with pre-operative rehabilitation

Suffering an ACL tear can be a debilitating injury both emotionally and physically. Taking immediate action prior to surgery through optimizing your knee in physical therapy is paramount to improve outcomes after surgery.

How will pre-operative physical therapy for your ACL tear set you up for success?

Current best evidence indicates optimizing knee function prior to surgery improves postoperative outcomes in patients with ACL tears.  Pre-operative physical therapy is essential to restore full range of motion, regain quadriceps contraction, normalize walking, decrease swelling, and learn how to use assistive devices.  Your physical therapist can test baseline strength, motion, limb circumference, and proprioceptive capabilities of your surgical and non-surgical limb not only as a measure to track your progress but to individualize your rehabilitative program. At the end of the day it is about getting back to the activities that are meaningful to YOU and the only way to truly know you are getting back to your prior level of function is to measure it consistently throughout the rehabilitative process.

What is the ACL?

The ACL (anterior cruciate ligament) is one of the ligaments that help stabilize your knee joint. It connects your thigh bone (femur) to your shinbone (tibia).

Why is the ACL important?

The ACL is important because its role is to stabilize your knee when cutting and pivoting as well as secondarily resisting hyperextension of the knee.  It prevents your shinbone (tibia) from sliding out in front of your thigh bone (femur) in the aforementioned activities.

What can you expect in your first post-operative visit?

Your physician will provide you with instructions on when they would like you to start physical therapy. In your initial visit, your physical therapist will review and reinforce any weight-bearing precautions, proper brace use, and proper assistive device use for walking.  Also, you will get to work on some low-level exercises to mitigate any further loss in muscle mass as well as light range of motion activities to get your knee moving again. One of the fundamentals of ACL rehabilitation is achieving full range of motion.  The reason this is so important is if the knee can’t fully extend (straighten), it makes it very trying for the quadriceps to regain full strength. Research tells us achieving greater than 90% quadriceps strength and a hamstring-to-quad ratio of at least 85% (compared to the non-operated knee) has shown to significantly decrease second ACL injuries. Here is a list of exercises your physical therapist may prescribe to you in your initial visit to help with restoring range of motion of your knee.

What is the rehabilitative process for an ACL tear like?

ACL recovery is a long and challenging process. However, having an experienced clinician with ACL rehab by your side to help guide you along the way will make all the difference with your outcome. Here at University Orthopedics we take an individualized approach to your ACL recovery in order to provide individualized care to what your goals are. You will be challenged in each and every physical therapy session with various exercises to optimize your strength and your dynamic neuromuscular control. Dynamic neuromuscular control is how an athlete controls their body when balancing, jumping, cutting, and landing. Your physical therapist will use a battery of validated return to sport tests to identify movement deficiencies which will be optimized to build further resilience in your surgical limb. Full recovery after an ACL surgery in athletes can take 9-12 months to return to pre-injury levels of function. Research tells us that nine months is the minimum recovery time after surgery and returning too early increases the risk of a second ACL injury.  Also, the research tells us that completing return to sport criteria reduces re-injuries by 32.5%. Those return to sport testing numbers are tracked initially pre-operatively, post-operatively and throughout your rehab process. ACL rehab is a long road but it is not one that you have to do alone, finding the right physical therapist is essential to safely return to sports. Our team of Physical Therapists is adept at treating ACL injuries and utilize up to date research to provide you with the appropriate challenge, for the necessary progress, to get back to the activities that are meaningful to you.

About the author:

Mark Murphy is a physical therapist at our East Greenwich office. He is also a sports medicine provider for University of Rhode Island Athletics. Mark received his Clinical Doctorate in Physical Therapy in 2019 from the University of Rhode Island. While Mark was at URI for his undergraduate degree in Exercise Science, he was an integral member of the football team for five seasons. Following his athletic career, he spent time as a strength and conditioning coach and assistant to the URI athletic training staff. Mark is recognized as a Certified Strength and Conditioning Specialist (CSCS) through the National Strength and Conditioning Association. Mark completed an Orthopedic Fellowship at Oxford School of Medicine and served as an Associate Professor of Human Anatomy for the medical students.  He has published several continuing education courses and is a guest lecturer for the URI DPT program & URI Kinesiology program. Mark has a passion for integrating strength and conditioning principles into rehabilitation to optimize human performance and is focused on post-operative management of athletic-related injuries.