The anterior cruciate ligament (ACL) is part of a group of ligaments that stabilize the knee joint. This ligament runs through the center of the knee joint between the two bones that make up the knee–the femur (thigh bone) and the tibia (lower leg bone). The ACL’s primary role is to restrain anterior translation of the tibia on the femur but aids in stabilizing against excess movement in other planes as well. Injuries to the ACL are commonly what are called “noncontact” injuries and often occur in athletes. This means that the athlete’s ACL was injured in a manner that did not include contact with another player. Usually this occurs when the knee hyperextends and rotates such as when a basketball player lands after a jump or when an athlete plants their foot in the grass while turning. This is in contrast to an injury that occurs while an athlete is contacted by another player. Football players, for example, often experience ACL tears as a result of a contact injury.

When the ACL tears it can lead to significant instability in the knee joint that makes it difficult to return to high levels of activity. A small subset of people termed “copers” manage to cope without reconstruction of the ACL but the vast majority of others will undergo ACL reconstruction using a graft from either a cadaver or their own hamstring or patellar tendons.

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PTs PLAY AN IMPORTANT ROLE IN ACL RECONSTRUCTION REHABILITATION

Recovering from an ACL reconstruction surgery can take 4-6 months but may take as much as a year for athletes wanting to return to competitive athletics. Prevention of re-injury while restoring function is the main goal of rehabilitation from this kind of injury. Your surgeon will likely provide your physical therapist with a protocol to help guide the recovery process but your PT will be in charge of developing a plan to restore normal range of motion, strength, neuromuscular control, balance, mobility and sport-specific skills. While my team and I will individualize a program to your specific needs, an ACL surgery rehabilitation program will usually incorporate these five principles:


Strength and neuromuscular control: Regaining leg muscle strength and motor control is an essential component of the next phase of rehabilitation. Exercises to improve leg muscle strength will be prescribed. Activities to challenge single leg balance and control of joint angles during tasks like a single leg step down or single leg squat are important to help recover neuromuscular control.

Agility, running and landing: Once good neuromotor control, muscle strength and flexibility have been established on the surgical side it is time to begin applying more load and stress to the knee to prepare it for return to sport and recreation. Under the supervision and guidance of a physical therapist the athlete will progress through a graded jumping, running, and agility program to improve the ability of the muscles, tendons and ligaments to withstand and control acceleration, deceleration and rotation.

Return to sport: Your physical therapist will use a series of functional and sport-specific tests combined with subjective and symptom reports to guide you in returning to your sport. Re-injury of the ACL is the biggest concern when returning to sport and it is important that your knee is ready to accept the stresses that returning to sport will place on it. Sport specific drills and graded return to sport are important components of this phase of rehabilitation

Preventing future injury: Now that you’ve done the hard work of recovering from an ACL injury, it is important to continue a program that will minimize the risk of re-injury of the same knee or injury of the opposite knee. Your PT will individualize a series of balance, strengthening, and plyometric exercises to be performed more than once a week to reduce the likelihood of future injury.

Facing recovery from an ACL injury can be daunting but my team of physical therapists and I are here to help make that process as smooth as possible. Call Evolve today to get started on your ACL injury recovery.

Call to Schedule a Consultation! 1-718-258-3300