The ACL is one of the most important ligaments of the knee, giving it stability. The ACL achieves this role by preventing excessive twisting , straightening of the knee ( hyperextension) and forward movement of the tibia on the femur. When these movements are excessive and beyond what the ACL can with stand, tearing to the ACL occurs .This condition is known as an ACL tear and may range from a small partial tear resulting in minimal pain ,to a complete rupture of the ACL resulting in significant pain and disability, requiring comprehensive rehabilitation and potentially surgery .
Before any treatment , encourage strengthening of the quadriceps and hamstrings, as well as ROM exercises. Performance of ROM helps reduce the amount of effusion and help the patient regain motion and strength.
PRICE –should be used in order to reduce swelling and pain , to attempt full range of motion and to decrease joint effusion.
Closed chain exercises are used to emphasize early and long term maintenance of full extension.
The therapy protocol may be divided into 4 phases
This is the preoperative period when the goal is to maintain full ROM
Phase 2 (0-2 week)
The goal is to achieve full extension , maintain quadriceps control, minimize swelling, and achieve flexion to 90 degree.
Phase 3 (3-5 week)
Maintain full extension and increase flexion up to full ROM . stair climbers and bicycle may be used.
Phase 4 (6 week)
Increase strength and agility, progressive return to sports .Return to all sports without activity may take 6-9 months and should be closely monitored by the surgeon and physical therapist
Other treatment – (injection , manipulation )
The use of knee braces remains a highly controversial topic, braces are well accepted by the patient ,but most biomechanical studies do not support their use. Studies have shown that functional bracing can limit anterior translation of the tibia at low loads. Most braces have been found to decrease the reaction time of the hamstring muscles.
This is a maintenance phase .The patient’s timeframe for returning to sports depends on his/her strength, ROM ,and the type of fixation that was performed.
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