GG10Rehabilitation Programme for Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction

Transcription

1 GG10Rehabilitation Programme for Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Femur ACL Graft Fibula Tibia The Anterior Cruciate Ligament (ACL) is one of the main ligaments in the knee. It lies inside the knee joint, running diagonally (front to back) across the knee. The main function of the ligament is to prevent the tibia (shin bone) from slipping forward on the femur (thigh bone) when the knee is under load. When the ligament is deficient, patient feels this as a sensation of the knee giving way. If this ligament ruptures it will not heal on its own but can be reconstructed. The reconstruction is carried out using one of two grafts: Patella Tendon (front of knee) Hamstring Tendon (back of knee) Patella Tendon Graft The patellar tendon is the structure on the front of your knee that connects the kneecap (patella) to the shin bone (tibia). The middle third of the patellar tendon, complete with its bony attachment at either end, is removed from the bad knee (ACL- deficient knee). This strip is then surgically fitted into the appropriate positions on the femur and tibia to mimic a natural ACL.

2 Hamstring Graft The hamstring muscles are the group of muscles on the back of your thigh. The tendons from the hamstring group is cut, stitched together and repositioned within the knee as a substitute for the lost ACL. Following hamstring graft surgery you MUST NOT stretch or contract your hamstrings for the first six weeks. Both operations are successful in approximately 90-95% of cases. It is important to remember that your new ACL will actually weaken after the surgery before it gets stronger. This happens as the body provides the graft with a new blood supply in a process called re-vascularization. This process begins at 4-6 weeks after surgery and it is at 4-6 weeks that the graft is at its weakest and most vulnerable. Re-vascularization is normally complete by 20 weeks. The strength of the new tendon increases in a process called remodelling. This occurs between 4-8 weeks in patellar tendon reconstruction and 12 weeks in hamstring tendon reconstructions. The entire process will take approximately one year.

3 INPATIENT GUIDELINES Following surgery, you will be admitted onto a ward. Depending on the consultant s post-operative instructions, you may be discharged home on the same day or the following day. Prior hospital discharge, you will be seen by a physiotherapist. You will be given a gentle home exercise programme, and taught how to use elbow crutches and climb stairs safely. Day 0-1 Post Op Control the swelling by elevating the leg on a pillow when resting (your knee and foot should be higher than your hip), but ensure your knee is in a straight position. You will get up and walk weight bearing through the operated leg as tolerated with 2 elbow crutches as advised by the physiotherapist. You will be taught how to safely climb the stairs using your elbow crutches. Aim to gently bend and straighten knee as pain allows (see exercises attached). You will be discharged home if all the above are satisfactory and there is no significant knee effusion (swelling) On discharge, a practice nurse letter will be given to you, to have your clips removed and application of steri-strips on the third day. Follow up Post operative review will depend on your consultants protocol You will receive a physiotherapy outpatient appointment within 2 weeks after your operation. Your physiotherapist will assess you and create an individualised exercise programme tailored to your needs. REHABILITATION You will also be required to attend a specialised ACL exercise class where your progress will be carefully monitored. Rehabilitation is divided into four phases: weeks o Reduce swelling (use ice as required) o Begin to increase the range of movement in your knee as pain allows (aim for 0-90 degrees of flexion- bend knee half way) o Be able to lift your leg up straight o Begin to increase muscle (quadriceps and hamstring) strength o Increase movement of patella (kneecap)

4 weeks o Restore full knee flexion (~130 o ) o Perform a full squat properly o Regain good balance and control o Re-establish correct walking pattern months o Regain full muscle strength o Increase agility o Be able to perform restricted sports- specific drills 4. 6 months onwards o Return to contact sports (~9-12 months) ADDITIONAL INFORMATION Crutches Driving Work o Required for first two weeks following surgery. o Once normal walking pattern achieved- elbow crutches are no longer required. o Allowed 6 weeks post- surgery or when you doctor/consultant advises o You will need to take 2-4 weeks off work for sedentary workers o 6 weeks off if your job is physically demanding Swimming Sport o When wound has healed and able to walk without crutches swimming is permitted. o Breast stroke NOT advised o No contact sport for 6 months o Contact sport allowed at 9-12 months Useful Telephone Numbers Orthopaedic Surgical Unit (OSU) Inpatient Physiotherapy Outpatients Physiotherapy

5 Personal Exercise Programme (From 0-2 weeks) Lying on your back. Bend one leg and rest your foot on the bed and put a cushion under the other operated knee. Exercise your straight leg by pulling your foot and toes up, tightening your thigh muscle and straightening the knee (keep knee on the cushion). Hold approx. 5 secs and slowly relax. Repeat 10 times. 3 times a day as able. Lying on your back with legs straight. Bend your ankles and push your knees down firmly against the bed. Hold 10 secs. - relax with aim of getting heel lifted. Repeat 10 times. Every 2 hours as able. Lying on your back with one leg straight and the other leg bent. (You can vary the exercise by having your foot pointing either upwards, inwards or outwards). Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20 cm off the bed. Hold approx 5 secs. - slowly relax. Repeat 5-10 times with both legs. Sit on a chair. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold approx. 10 secs. and slowly relax your leg. Repeat 10 times.

6 Sitting with your arms crossed. Stand up and then sit down slowly on a chair. (This can be made easier and more difficult by changing the height of the chair) Sitting. Bend your knee as much as possible. To gain a stretch you may bend your knee as much as possible and hold the position (using your hands) for secs. Sitting on a chair, with the leg to be exercised supported on a chair as shown. Let your leg straighten in this position. Hold 10 secs. ** DO NOT DO THIS EXERCISE IF YOU HAVE HAD A HAMSTRING GRAFT (UNTIL 6 WEEKS AFTER SURGERY) ** Stand. Hold on for support as needed. Push up on your toes. Repeat 10 times. 3 times a day.

7 Lying face down with your hips straight and knees together. Bend your knee as far as possible keeping hip straight and ankle flexed. Hold approx secs. Repeat 3-5 times. Sit with your leg straight. Push your knee cap towards your opposite leg. Hold approx. 10 secs. Sit with your leg straight. Push your knee cap outwards. Hold approx. 10 secs. Stand with your legs crossed and holding on to a support. Keeping your body, knees and feet straight forward slide your front leg backwards until you can feel the stretching on the outside of your hips and thighs. Hold approx. 20 secs. - relax. Repeat with the other leg in the front. Repeat 3 times. 2-3 times a day as able