Acl guidelines
Criteria dependent protocols not time dependent
Written by: Ahmed Elhabashy
Thanks to:
Dr: Rafiq radwan
Dr: Sherif Owida
Dr: Abdallah
جروب صباحك طبيعي
Acl rehab +or- meniscectomy (6 –12 months)
Preoperative rehab (if there is no avulsion fracture as blood promote healing):
Decrease swelling
Get full knee extension
Strength both lower limbs (the sound leg will be the reference along the post rehab)
Post operative rehab:
Assess the tunnel position شوف الرباط محطوط في مكانه الصح وال ال
Aims Exercise
Pain Cold compression unit or Ice (10m every 4h)
Swelling Interferential current - Ultrasound (pulsed 1:4 for 10 m) – massage for lymphatic drainage - Compression socks –
(<1 cm) wedge for raising lower limb – coagulant (heparin - aspirin)
CPM – Patellar mobilization – Soft tissue release around patella (not vigorous to prevent reflex spasm)
CKC knee flexion (use long towel, sliding socks, gel as assistive devices) (fig.1)
(full knee extension -90 flexion)
Hamstring stretch with ankle dorsiflexion to increase knee extension (fig.2) (with
internal and external rotation to stretch all muscles of hamstring) Figure 1 CKC knee flexion
ROM
Figure 2 Hamstring stretch
(0-2nd week)
Phase 1
Long Brace for full extension (if there is extension lack; you can use it during exercises to activate all fibers of
quadriceps)
Bike with high chair and no resistance if knee flexion is more than 70
Gait with partial weight bearing using crutch
bearing
من وزن الجسم%100 الي20 استخدم الميزان عشان تزود الحمل تدريجي من
Weight
مشيه صح وخليه يرفع رجله علي قد مايقدروخطوات الماشيه تكون متساويه
كرر المشي ده وانت فاتح عينك وبعدها كرره وانت مغمض
بستغني عن الع كاز لما المشي بتاعه يبقي كويس ويقدر يقف علي رجل واحده وده غالبا بعد اسبوعين
Acl Proprioception (fig.3) (making slight tension of the graft to be acl)
Proprioception
(from 3rd day)
Figure 3 Acl Proprioception
Distal control; I need proprioception (fig.4) (do planter and dorsiflexion)
Figure 4 Distal control
Coactivation between quadriceps and hamstring (fig.5) against wall in closed packed
position
Cooactivattion between
muscles (from 3rd day)
Forward and backward step of the affected limb from stance
Step ) علي سلمهup with good limb and down with bad limb( Figure 5
By using gymnastic ball go forward & backward – squat to 20 degrees (fig.6) (with
theraband around thigh to strength abductors)
Figure 6
doing open kinetic chain exercises of knee extension to avoid graft rupture
Never
doing isotonic quadriceps exercises until getting full extension to prevent chondromalacia عشان ماتشغلش الياف في العضله والياف ال
using aggressive movements to prevent muscle guarding
ending the exercises with knee flexion to prevent flexion reflex spasm
Swelling لو مش راضي يقل اعمل حجامه
(<0.5
cm)
Exercises of ROM in phase 1 + free OKC knee extension from setting and prone (use brace if there is extension
lack to activate all fibers of quadriceps) movement is slow to activate all fibers of qaudriceps
(full knee extension - 125 flexion)
Circumduction (slowly) of the affected limb with extended knee from prone
Stretch hip flexors if knee flexion is lack
Use Russian current
Knee flexion assisted by sound leg or belt (increase the lever arm of belt gradually) (fig.7)
ROM
Figure 7 assisted knee flexion
3rd week
if there is extension lack at the end of this stage:
ask patient to use the brace + stretch hamstring (by hot packs) + make external rotation of tibia
manually or by tape (from fibula) during extension to get locking mechanism +
Strength
Phase 2
To reduce valgus risk factor, strength:
Abductors + Gluteus maximus + hip external rotators + Core muscles + calf muscles (ankle planter flexion with
standing and setting to strength both gastrocnemius and soleus. Use theraband around thigh as a progression)
Exercises for soleus strength:
Acl proprioception: Isokinetic device
Or use marks to give sense of movement and sense of speed of acl (then repeat with closed eyes) (fig.8)
Proprioception
4 -6 week
حرك رجلك
بسرعه وكررها
بنفس السرعه
th
وعينك مقفوله
th
Figure 8
Stand on the sound side (fig.9) (start free then progress using theraband around thigh) Figure 9
Squat using gymnastic ball (with theraband around thigh to strength abductors)
Cooactivattion between muscles
Gait training (with theraband around thigh)
Side to side (with theraband around thigh)
Circumduction of thigh (with theraband around thigh) (fig.10)
Figure 10
Step up and down (to encourage shifting weight on the affected limb) go forward,
backward and side to side (fig.11)
Figure 11
Balance By using balance board (move forward, backward, side to side, squat, وهو واقف احدفله كوره
Devices Treadmill with low speed
Elliptical device
ROM Patient use the foam roll slowly to release the calf, hamstring, iliotibial band, peronii (lateral aspect of leg)
(full knee Repeat 5 times on each muscle
extension
and
flexion)
Russian current
Quadriceps strength with minimal resistance. the safe range: OKC is 80:40 knee flexion – CKC (leg press) is 0:40
Quadriceps & hamstring strength
knee flexion
(7th-12th week)
Patient from setting hold knee extension in (90-60-30) degrees of knee flexion then slowly down
Phase 3
Terminal extension exercise (fig.12) The band is at or above the knee not below the knee to prevent
anterior translation of tibia Figure 12
https://www.facebook.com/Dr.Sherif.Owida/videos/3390637741009186/1:44 اتفرج علي الفيديو من اول الدقيقه
Straight leg raising from prone (progress: with theraband around foot resisting knee valgus)
Restrictive blood flow training
Isometric training with gymnastic ball (fig.13)ميزه الكوره انها بتدي للعضله وقت عشان كل االلياف تشتغل
Figure 13
Hamstring strength
Jumping (forward, backward, side to side). Progression: increase height then use theraband around thigh
Note: land on heels
Control of bilateral Lower limb
بيلف يف الهوا بيلف يف الهوا وينط لقدام ولورا والجنب
Standing on half ball. Progression: shift weight forward, backward, side to side, semi squat
Control of lower limb with
uper limb
lunges while moving
the upper limb Moving the برميله الكوره يف اتجاهات مختلفه Shifting the weight
dumbbells while during exercise
standing on half ball
lower limb
Control of
unilateral
Stand on the affected side
Use isokinetic device before phase 4 to check the strength of the maximum strength of quadriceps and hamstring
the strength of the affected muscles must be more than 75% of the sound side
المراحل الجايه بيتابع مع مدرب متخصص وبتتعمل في الملعب الي هيلعب فيه وبيركز علي النواقص الي عرفتها من جهاز االيزو
بس ده الخالصهhttps://www.facebook.com/Dr.Sherif.Owida/videos/3435013969904896/ ممكن تتفرج علي الفيديو ده بعد اول ساعه
Warm up: جري خفيف عشر دقايق-dynamic stretch of lower limb with upper limb مايبصش علي االرض وهو بيسخن
Quadriceps & hamstring of the affected side: Start with 50% of maximum strength of muscles
Strength all muscles of the body
Strength gradually
(3rd-6th month)
Plyometric exercises
Functional/sport-related activity
Phase 4
Straight line jogging
Swimming (light kick)
Straight line running at 3 months
Progressing to sport specific running and agility (progressively sequenced) (running forwards, sideways,
backwards, sprinting, jumping, hopping, changing directions, kicking)
Restricted training
At the end of exercise do static stretch
Use isokinetic device before returning to sport to check the strength of the maximum strength of quadriceps and hamstring
the strength of the muscles must be > 85% of the standard numbers
نصايح
تكرار التمارين مهم عشان عايز المخ يعمل الحركه وهو مغمض
ساعد العيان نفسيا
العيان ينام كويس ويتغذي كويس
control of unilateral lower limb لو العيان تخين مش الزمن اصعب عليه واعمل
ال انت.المراحل دي تعتمد علي حالة العيان يعني لو العيان جالك تاني اسبوع مش منطقي تقوله انا همشي معاك ببرامج تاني اسبوع
بتشوف حالته وعلي هذا االساس بتشتغل معاه
ده هممكن يدخله في قطع للرباط الصليبي في الرجل السليمه.ماينفعش نهمل الرجل السليمه ونحمل عليها اكتر من الالزم
هسوق العربيه امتي؟
:لو العربيه اتوماتيك
والرجل اليمين سليمه تقدر تسوق من تاني اسبوع عشان انت بتتحكم بالرجل اليمين
والرجل اليمين تعبانه تسوق بعد شهر
