22/04/2023
ACL (anterior cruciate ligament) injuries are common knee injuries that occur when the ACL, which is one of the four major ligaments in the knee, is damaged or torn.
The ACL is responsible for stabilizing the knee joint, and an injury to this ligament can lead to pain, swelling, and instability in the knee.
ACL injuries often occur during activities that involve sudden stops or changes in direction, such as jumping, landing, pivoting, or twisting.
Athletes who play sports that involve these types of movements, such as soccer, basketball, and football, are at a higher risk of sustaining an ACL injury.
Symptoms of an ACL injury can include a popping sound or sensation at the time of the injury, pain and swelling in the knee, instability or a feeling of giving way in the knee, and difficulty walking or bearing weight on the affected leg.
Treatment for an ACL injury may involve rest, ice, compression, and elevation (RICE) to reduce pain and swelling.
Physical therapy may also be recommended to help restore range of motion, strength, and stability in the knee.
In some cases, surgery may be necessary to repair or reconstruct the ACL, especially for athletes who wish to return to high-level sports participation
ACL Rehabilitation
Creating a Plan:
👨⚕️As a physiotherapist, you have a role in guiding your patient through a long-term rehabilitation plan.
🏋️Setting up milestones and goals depends on your patient's needs and aspired function.
♿Predicting outcomes and time-frames, using your clinical experience and clinical reasoning skills, for each goal is also part of your role.
The ACL rehabilitation plan has 9 Phases:
1️⃣ROM:
Aiming to maintain available range and facilitate regaining of full ROM. At this phase you should also manage effusion and inflammation and achieve knee terminal extension. This stage starts immediately after surgery and lasts up to the 6th week.
2️⃣Increase Weight Bearing tolerance gradually:
Depending on the complexity of the injury:
✴️A single ACL injury :
Itrequires 2 weeks of partial weight bearing, then the patient is allowed full weight bearing.
✴️ACL injury combined with other:
ACL injury combined with meniscus and/or chondral injury would take up to 6 weeks to full weight bearing. In this case, we need to increase the tolerance gradually
3️⃣Building muscular endurance:
This also depends on the joint pathology and may take up to 8 weeks. So this goal is expected to be achieved between the 10-18th week of rehabilitation.
4️⃣Developing strength:
Research shows weakness in hip, knee and ankle muscles following ACL injury with knee flexor and extensor weakness persisting for longer periods after surgery. Expected regaining of strength between 19-26th week.
5️⃣Muscular power:
Time frame around 27-32th week.
6️⃣Building running tolerance:
Not all sports demand the same volume of running.Depending on the athletic's needs, start a designed running program on the 27th week over a 4-6 weeks period.
7️⃣Speed and agility training:
At week 32, introduce uni-directional drill training for a week then progress to multi-directional training.
8️⃣Return to training:
Expected around week 35.
9️⃣Return to play:
Around week 38.
