ACL Reconstruction with Patellar Tendon Autograft
ACL Reconstruction with Patellar Tendon Autograft
ACL Reconstruction with Patellar Tendon Autograft
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<strong>ACL</strong> <strong>Reconstruction</strong> <strong>with</strong> <strong>Patellar</strong> <strong>Tendon</strong> <strong>Autograft</strong>Pre-op Education: Instruct the patient in ankle pumps, quad sets, seated kneeflexion, supine SLR, hamstring stretches, gait training <strong>with</strong> crutches and protection of thegraft.Post-op Program:POD 11. Ankle pumps – 20-25 per hour2. Active flexion as tolerated3. Gait <strong>with</strong> crutches and brace locked in full extension. (WBAT)4. <strong>Patellar</strong> mobilizations5. Polar care/ cryotherapy6. Dressing change7. Sleep <strong>with</strong> brace locked in full extension8. Quad setsPOW 1-41. Continue as above2. Start SLR’s: start standing, then sitting, then supine3. May use e-stim to promote quad recruitment4. Progress active flexion and encourage full extension5. Begin passive ROM to 906. With good quad control, may ween from brace. Usually in 2 -3 weeks.7. Teach gait training, emphasizing heel-toe, good quad isolation, normalknee flexion and push-off.8. Start the following open chain exercisesa. Sidelying hip abduction and adductionb. Sitting hip flexionc. Ankle therabandPaul G. Kiritsis, M.DKnee & Shoulder SpecialistSt. Francis Medical Center13700 St. Francis Blvd.Suite 103Midlothian, VA 23114(804) 379-2414 phone(804) 379-2413 faxwww.KneeAndShoulderSurgery.com
d. Standing hamstring curls to tolerance9. Begin closed chain knee exercises: ENCOURAGE PROPERTECHNIQUE AT ALL TIMES.a. Single leg stance: level to unlevel surfacesb. Therakicks: progress resistance, speed, arc of motionc. Walking forward, retro, and sidesteppingd. Standing calf raises, wobble boarde. Wall slidesf. Leg pressg. Stationary bike10. Encourage upper extremity strengthening for overall conditioning11. Continue modalitiesPOW 4-101. Continue as above2. Progress exercises for building strength and endurance-4-6 sets of 15-20 reps-progress from double to single leg and concentric to eccentric-emphasis on closed chain activities onlya. leg pressb. squatsc . lunges (front/side/back)d. step-upse. leg curlsf. hip strengtheningg resisted walking3. Exercises for balance and proprioception-progress from local to whole bodya. mini-trampb. Sport cordc. Slide boardd. Swiss ball4. Exercises for endurancea. Bikeb. Stairmasterc. Elliptical trainerd. Treadmill walkinge. Aquatic exercisePOW 10-16Paul G. Kiritsis, M.DKnee & Shoulder SpecialistSt. Francis Medical Center13700 St. Francis Blvd.Suite 103Midlothian, VA 23114(804) 379-2414 phone(804) 379-2413 faxwww.KneeAndShoulderSurgery.com
1. Continue as above but slowly progress weight and decrease reps (8-10)a. Increase loadb. Decrease time and increase power2. Progress walking to a fast walk then walk/jog on treadmilla. High knee marchb. Figure of “8”3. Begin jumping rope.a. ShuttlePOW 16-return to sport1. Progress jump roping to line jumps, then box jumps, and then distancejumps2. Begin sport specific drills3. Progress speed and intensity of above activitiesReturn to Athletics Criteria1. Satisfactory clinical exam2.
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