Have you had Cruciate surgery or in the process of scheduling it?
Clara Linnane and Paul Sweeney are our Knee Specialists here in ProActive Physio and have done extensive research into Anterior Cruciate Ligament (ACL) injuries .
Our approach for our Cruciate Clinic includes;
Early Phase
- Focus on pain management and swelling. Use walking aids as needed, compress the joint, elevate and take pain relief as prescribed and needed
- Focus on ROM – Regain knee extension as quickly as possible. Also focusing on regaining flexion over time. Little and often is key!
*Poorly managed pain can result in; - limping
- decreased quads activity
- decreased ROM – optimally wanting to have full knee extension and +90 deg flexion by 3/52 to prevent cyclops lesion developing
- increased atherogenic inhibition (use of muscle stim in the clinic that can be used in the early phases to help reduce this)
- increased muscle atrophy
- increased fear-avoidance/frustration
Strength training - Will always use isometrics to begin the loading process – important not to neglect donor site (BPTB/Hamstring/Quad)
- Progressive loading over time rather than being too aggressive too soon. Use a mix of closed-chain and open-chain exercises
- TEST Don’t Guess – Completed ideally with isokinetic testing. Can also use HHD in the clinic to progressively measure strength
Use of Patient Reported Outcome Measures to Assess psychological readiness/fear avoidance. Again progressively tested overtime initially starting at the 3-month mark
Proprioception - Will discuss with patients that balance is another important piece of the puzzle that needs to be targeted
- The difficulty of these type of exercises overtime starting with SL eyes open/closed to rolled up towel/wobble boards to stepping of a low step with eyes closed
Plyometrics - Try to initiate plyometrics as soon as possible (once sufficient strength has been regained)
- Will discuss with the patient that while horizontal jump/landing should not be neglected I will focus more on vertical jumps
- I use the MyJump App to test vertical jump heights on the following; DL CMJ, SL, CMJ, DL/SL Drop Jump
- I will discuss with patients that regaining Reactive Strength Index (ability to repeatedly hop for example) is key to allowing a safe RTS
Sports Specific - Overtime, introduce sport-specific drills that start as planned in nature and progress to reactive/unplanned
**Always letting patients know that optimally will want to get all testing criteria within 10% of the opposite limb/baseline.
**Never rush a return to sport. The knee will be ready when it’s ready!
