Treatment for ACL Injuries

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Lunge exercise

If an ACL injury is suspected, we strongly advise you seek a professional medical opinion as soon as possible to confirm the diagnosis and refer to an orthopaedic consultant to decide whether surgery is indicated.

ACL rehabilitation programs consist of initial first aid, mobility, strength, balance, fitness and agility exercises and they are progressed over a period of months.

Immediate first aid

Immediate first aid for ACL tears involves applying the P.R.I.C.E. therapy principles. This should be applied for at least the first 72 hours or until a specialist opinion is sought. P.R.I.C.E. stands for Protection, Rest, Ice, Compression and Elevation and is used for almost all sports injuries.

Protection of the torn or sprained ligament is vital to prevent further damage and to enable the healing process to begin as efficiently and effectively as possible. We advise using crutches to minimise weight bearing through the knee joint and to wear a protective hinged knee brace to limit the movement in the knee and provide additional support to the joint.

Rest is one of the most important components of P.R.I.C.E but is so often neglected or ignored. Stop training immediately and allow the injured area to start healing. ACL injuries usually cause instability within the knee and therefore by continuing to exercise this may result in further injury and possibly sustaining injuries to other ligament and structures within the knee or surrounding joints.

Ice therapy, also known as 'cryotherapy' is cheap, easy to use and requires very little time to or expertise to prepare. In the acute stages, the application of an ice pack to the knee can substantially limit the inflammatory reaction that naturally occurs after such an injury and allows the body to start healing the ligament and thereby reduces the overall recovery time. Icing achieves this in a number of different ways:

  • Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).
  • Reduces pain (pain gate theory)
  • Reduces muscle spasm
  • Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism

Do not apply ice directly to the skin or leave the it on for more than 15 minutes as it may cause ice burn. Use a wet towel or cold therapy compression wrap. Check for contraindications if you are unsure.

Compression - applying compression to the injury will help to minimise the amount of swelling by compressing the blood vessels. Compression can be applied through a number of methods and the most cost-effective is by using a compression bandage which is an elasticated bandage that fits around the affected limb. Using a knee brace can often double up by providing both additional support and compression at the same time.

Elevation is the final principle used of P.R.I.C.E. and is equally as important as the other 4. Elevation of the leg above the level of the heart allows gravity to drain the fluid away from the injured knee reducing swelling and pain.

The ACL rehabilitation program is sperated into 6 phases and should be closely monitored by a physiotherapist or sports therapist according to your surgeon’s rehabilitation protocol.

Pre-surgery

Aims:

  • Control swelling
  • Restore full mobility of the knee.
  • Maintain strength of the quadriceps and hamstring muscles.
  • Regain normal walking patterns.

Home treatment:

  • Apply the PRICE principles of rest, ice compression and elevation.
  • Wear a hinged knee brace to protect the knee from further injury.
  • Perform patella mobilizations.

Exercises:

  • Knee mobility exercises including heel slides, knee flexion and prone knee hangs.
  • Ankle mobility exercises.
  • Quadriceps and hamstring isometric exercises (static contractions).
  • Hip strengthening exercises including bridging and adduction.

Progression criteria to next stage (post surgery):

  • Has swelling and inflammation reduced?
  • Can the knee be bent and straightened?
  • Are you confident walking on crutches?
  • Is the wound clean and healing well?

Phase 1b

Aims:

  • Control swelling.
  • Improve bending of the knee up to 90 degrees.
  • Improve straightening of the knee to full.
  • Continue quads and hamstrings contractions.
  • Walk partial weight bearing in crutches.

Home Treatment:

  • Apply principles of P.R.I.C.E.
  • Wear a Knee Brace to protect the knee from further injury – your surgeon will advise on how much movement the brace should allow.
  • Continue to perform patella mobilisations.

Exercises:

The following is for information purposes only and only acts as a guide – always follow your surgeon’s/therapists advice.

Exercises that are typically introduced at this stage, in addition to the previous stage’s exercises are;

  • ¼ squats.
  • Bridging.
  • Step ups.
  • Static bike – high seat with NO resistance, in pain free range of movement.
  • Hamstring curls – only if patella tendon graft is used, not Hamstring graft.
  • Calf Raises.

Progression Criteria to next stage:

Full extension of the knee, 90 degrees of knee bend, minimal swelling and inflammation, straight leg raise (with no lag).

Phase 2: 5 weeks to 12 weeks post surgery / injury

Aims:

  • Control swelling.
  • Improve bending of the knee up to 120 degrees.
  • Maintain full straightening of the knee.
  • Improve quads and hamstrings strength.
  • Continue walking with a “normal” pattern, increase proprioception and balance.
  • Remove Brace at 6 weeks.

Home Treatment:

  • Continue to apply cold therapy post exercises.
  • Continue to perform patella mobilisations.

Exercises:

Exercises that are typically introduced at this stage, in addition to the previous stage’s exercises are:

  • ½ squats.
  • Lunges.
  • Leg Press.
  • Step downs.
  • Static bike - high seat with NO resistance, in pain free range of movement.
  • Sit to stand.
  • Single leg balance exercises.

If any of the exercises above are painful during or after performing them then stop immediately.

Progression Criteria to next stage:

Minimal swelling and inflammation in the knee, 120 degrees of bend in the knee, full movement and no pain around the patella (knee cap), improving balance.

Stage 3 – Week 13 to 20

Aims:

  • Continue to control swelling.
  • Regain full movement of the knee.
  • Continue to improve quads and hamstrings strength.
  • Continue to work on balance and proprioception.
  • Start jogging and progress speed straight line only.

Home Treatment:

  • Continue to apply cold therapy post exercises.
  • Continue to perform patella mobilisations.

Exercises:

Exercises that are typically introduced at this stage, in addition to the previous stage’s exercises are:

  • Hopping single leg.
  • Double leg jumps.
  • Static bike.
  • Jogging – start slowly and ensure there is no limp before going quicker.
  • Increase running speed slowly and progressively over a period of weeks BUT ONLY IN STRAIGHT LINES WITH NO TURNING.

If any of the exercises above are painful during or after performing them then stop immediately.

Progression Criteria to next stage:

No inflammation or swelling in the knee, full movement in the knee, improving strength and balance around the knee, no pain on running or reactive swelling post running.

Stage 4 – Weeks 21+

Aims:

  • Introduce twisting, turning and cutting movements.
  • Introduce ball work (if required).
  • Continue to improve balance around the knee.
  • Achieve at least 90% strength in the quads and hamstrings in comparison to the other uninjured leg.
  • Improving confidence.

Home Treatment:

  • Continue to apply cold therapy post exercises.
  • Continue to perform patella mobilisations.

Exercises:

The following is for information purpose only and only acts as a guide – always follow your surgeon’s advice.

Exercises that are typically introduced at this stage, in addition to the previous stage’s exercises are;

  • Box Jumps
  • Start to gradually introduce twisting and turning movements.
  • Start to introduce striking a ball (if required).
  • Start to perform functional sports specific drills.