Post op ACL Flashcards
Pre-op considerations
pain
effusion
Range of motion
Muscle function
Extension lag
Gait
How angry is it?
Postop considerations
initial graft strength
graft type
Healing and maturation of graft
autografts
Faster incorporation and healing
Better outcomes in young active patients
donor site morbidity
Risk of fracture
allografts
less acute pain
greater decrease in structural properties
slow rate of biological incorporation
better for revisions
BPTB autograph
higher incidence of PFP
persistent quad weakness
injury to extensor mechanism
avoid early heavy eccentrics
modify squats to minimize PF compression forces
hamstring autograft
less aggressive early on
no isolated hamstring strengthening until pow 8
hamstrings and transverse plane control
allograph rehab implications
rehab following allograft reconstructions may need to be less aggressive compared to autograft rehab
12-15 mo potentially
Initial post operative goals
quickly restore, full passive extension
Restore patellar mobility
Control postop inflammation
Gently and slowly increase flexion RO
Establish and increase volitional squad strength
Restore normal gait pattern
when do you want full passive knee extension post op?
1-2 weeks
When do you want full active extension?
Within 3-4 weeks
when do you want 100 degrees flexion by?
2-3 weeks
post op full flexion within
4-6 weeks
restoring ROM
Wall slides rather than assisted heel slides
Low load, long, duration, heal prop rather than prone hangs
Frequent extension mobes rather than being aggressive
functional carryover is vital
Address effusion
which range to stay in during open chain activities
avoid the last 30° of knee extension
Stay within 90- 60° flexion
Knee curls range
0-90 degrees
neuromuscular control
Altered perception and neuromuscular control
Unclear if they fully resolved after ACL repair
Need to be a focus of rehab
Neuromuscular training, exercise phase 1
two legged task or uni directional single leg task
Master basic component technique control out of plane, motions of extremities and trunk
Neuromuscular training phase 2
double to single leg transition, decreasing stability of support surface narrowing base of support
Integrate additional component of task without compromise of technique
neuromuscular training, phase 3
Introduction of second perturbation to the athletes, neuromuscular system
Athlete is able to avoid loss of balance or form under perturbed conditions
neuromuscular training phase 4
Multi directional tasks that demand explosive movements and quick repetition
Unstable surfaces and destabilizing perceptions
Quick, explosive, precise movements with rapid response to perturbations and without feedback from instructor
Return to sport testing
YBT, FMS
Hop testing
Tuck jump assessment
Landing error scoring system
Agility drills
Fatigue protocol
kinesiophobia measures
