Post op ACL

Question 1

Pre-op considerations

Answer 1

pain
effusion
Range of motion
Muscle function
Extension lag
Gait
How angry is it?

Question 2

Postop considerations

Answer 2

initial graft strength

graft type

Healing and maturation of graft

Question 3

autografts

Answer 3

Faster incorporation and healing
Better outcomes in young active patients
donor site morbidity
Risk of fracture

Question 4

allografts

Answer 4

less acute pain
greater decrease in structural properties
slow rate of biological incorporation
better for revisions

Question 5

BPTB autograph

Answer 5

higher incidence of PFP
persistent quad weakness
injury to extensor mechanism
avoid early heavy eccentrics
modify squats to minimize PF compression forces

Question 6

hamstring autograft

Answer 6

less aggressive early on
no isolated hamstring strengthening until pow 8
hamstrings and transverse plane control

Question 7

allograph rehab implications

Answer 7

rehab following allograft reconstructions may need to be less aggressive compared to autograft rehab

12-15 mo potentially

Question 8

Initial post operative goals

Answer 8

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

Question 9

when do you want full passive knee extension post op?

Answer 9

1-2 weeks

Question 10

When do you want full active extension?

Answer 10

Within 3-4 weeks

Question 11

when do you want 100 degrees flexion by?

Answer 11

2-3 weeks

Question 12

post op full flexion within

Answer 12

4-6 weeks

Question 13

restoring ROM

Answer 13

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

Question 14

which range to stay in during open chain activities

Answer 14

avoid the last 30° of knee extension

Stay within 90- 60° flexion

Question 15

Knee curls range

Answer 15

0-90 degrees

Question 16

neuromuscular control

Answer 16

Altered perception and neuromuscular control

Unclear if they fully resolved after ACL repair

Need to be a focus of rehab

Question 17

Neuromuscular training, exercise phase 1

Answer 17

two legged task or uni directional single leg task

Master basic component technique control out of plane, motions of extremities and trunk

Question 18

Neuromuscular training phase 2

Answer 18

double to single leg transition, decreasing stability of support surface narrowing base of support

Integrate additional component of task without compromise of technique

Question 19

neuromuscular training, phase 3

Answer 19

Introduction of second perturbation to the athletes, neuromuscular system

Athlete is able to avoid loss of balance or form under perturbed conditions

Question 20

neuromuscular training phase 4

Answer 20

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

Question 21

Return to sport testing

Answer 21

YBT, FMS
Hop testing
Tuck jump assessment
Landing error scoring system
Agility drills
Fatigue protocol
kinesiophobia measures