Anterior cruciate ligament (ACL) injuries occur more than 250,000 times per year in the United States.(Griffin 2006) The majority of these injuries are treated with surgical intervention to reconstruct the ACL.(Mall 2014). Northside Hospital Sports Medicine Network uses a criterion-based rehabilitation guideline to ensure the optimal level of success with return to sport. Each individual will be treated uniquely based upon the observations of the sports medicine team. It is vital that a multi-factorial approach is used during rehabilitation to decrease risk of re-injury. Safety of the patient is the number one priority.
|Jogging||Low-level agility||Cutting||Return to Sport|
|Autograft||4-5 months||5-6 months||6-7 months||9+ months|
|Allograft||5-6 months||6-7 months||7-8 months||10+ months /td>|
Timelines are estimated based upon current literature studying graft healing and patient progress in formal physical therapy. Concomitant procedures such as a meniscal repair may delay the timeframes listed above.
- Risk of knee reinjury was reduced by 58% for each month RTS was delayed until 9 months after
surgery (Grindem BJSM 2016)
- Those who returned to level I sports had a 4.68 times higher risk of knee reinjury than those who
did not (Grindem 2016)
- Level 1 sport – Jumping, pivoting, hard cutting (basketball, football, soccer) (Daniel 1994)
Contact physician IF:
- Symmetrical knee extension not achieved by 4 weeks post-op
- > 2+ effusion on modified stroke test at 4 weeks post-op
- When athlete has passed functional return to sport testing and requires final clearance
Do NOT progress at any point if patient experiences any of the following:
- Significant increase in joint effusion
- Obvious deviation in gait pattern
- Increase in anterior knee pain!
- Schedule post-op PT visit for 3-5 days after surgery.
- Please ensure follow up visit with MD scheduled within 2 weeks after surgery
- Flexion AROM limited to 60 degrees until 1 week post-op
- Complete home exercise program as outlined in handout
- Purchase NMES unit as recommended by surgeon and bring to initial PT evaluation
Initial Post-op Instructions
- No bathing or submerging the incision in water until the sutures have been removed by the
physician, the scabs have fallen off, and the skin is completely closed
- Showering is allowed after the surgical dressing is removed; a waterproof dressing is not needed
as the incision can get wet. A shower seat may be used to decrease the risk of falls.
- Steri-strips will be used after suture removal by the physician to assist with incision closure. Allow
steri-strips to fall off in their own time. No need to replace once they have fallen off.
- Weight-bearing as tolerated (WBAT) with the use of 2 crutches immediately after surgery unless
instructed otherwise by the physician
- For R knee surgery, no driving for 4-6 weeks. Patients are medically liable if in a motor vehicle collision.
- For L knee surgery, patients may drive after 1 week as long as they have an automatic transmission vehicle and
have discontinued use of narcotic
Brace Use Post-op (Manske 2012)
- Brace will be locked in full extension until initial PT evaluation. May be unlocked at that time
- Brace use can be discontinued using same criteria as discharging crutch use starting at 2-4 weeks
- Brace use may be continued on individual basis per discussion with surgeon/PT