Kinesitherapy after ACL reconstruction begins immediately after surgery. A good surgical intervention is a necessary condition for the correct movement of the joint and restoration of the functionality of the limb. The importance of kinesitherapy after ACL reconstruction is equivalent to that of surgery. Incorrectly conducted kinesitherapy can lead to a functional deficit that hinders sports activities and even activities of daily life. In other words, surgical intervention restores the integrity of the damaged structures, and kinesitherapy restores the correct arthrokinematics and normal functionality.
The role of kinesitherapy
Under kinesitherapy we must understand analytical therapeutic gymnastics. This puts the patient in an active position and makes him part of the healing process. Physio fitness, as it is now fashionable to call it, provides movement, and this is the only thing necessary to restore normal function. Often, in my practice, I work more on the unpleasant consequences of immobilization, which is necessary for the restoration of damaged structures – bones, joints, etc. The only tool in this fight is exercise. The process of building a correct, individualized program of exercises, with a dosed progressive load, requires the least knowledge of the anatomic-physiological features and the operative approach.
Recently, we have been witnessing a tendency to animate patients in expensively equipped centers. The patient was placed prone in a passive position, receiving various physical therapy modalities, and the kinesitherapist was transformed from analytical specialist to machine operator. This serves only financial interests and is often ineffective, unnecessarily lengthening recovery times.
Indeed, apparatus physiotherapy and kinesitherapy go hand in hand. In the initial postoperative period, when the limb does not tolerate load, it is normal for the therapy to be more passive, but the tendency should be aimed at increasing the dosed load at the expense of passive physiotherapy modalities. We should see them as helping.
Timing, protocols, and approach in kinesitherapy after anterior cruciate ligament reconstruction
Recovery timelines and protocols can provide rough guidelines for functional capabilities and progression in an exercise program. The experienced therapist is not guided by programs, but by the type of surgical intervention, the current state of the joint and his assessment of the patient’s physique and psyche. In this regard, any deadlines and protocols can be individualized. This depends on the following factors:
- the type of trauma and the operative approach. The injury may be isolated or complex involving multiple structures. Often, entering and examining the knee on the operating table also reveals cartilage defects, which surgeons look to influence with additional operative techniques to stimulate cartilage. The presence of a meniscal tear and its potential for suturing would preserve the anatomical integrity of the knee structures, but would directly affect the range of motion due to the need for immobilization with a splint. Therefore, a detailed familiarization with the operating protocol and following the operator’s recommendations is necessary.
- the patient’s physique. People who lead an active lifestyle have a better sense of self, which helps them know when the moment of overload occurs and helps them avoid it. The better overall physical fitness and culture in general is not an understatement here.
- the psyche of the patient. Some people take their trauma extremely hard and become hyperactive in their desire to recover faster. With them, the progression of the load goes one idea slower and gentler. Some things take time, and in this regard I can summarize: no one can outrun nature. The other opposite is the more passive patients. Their approach is more demanding and motivating.
- as a rule, kinesitherapy after ACL reconstruction preceded by preoperative mobilization proceeds more easily.
You can read more about the timelines, protocols and trends in promoting the reconstruction of the ACL here.
Key points in kinesitherapy after anterior cruciate ligament reconstruction
In general, the periods are divided into several stages. Here are the main highlights in them:
- Early postoperative. Here the period is gentle. It works in the direction of early activation of the quadriceps, folding is done passively with the help of an arthromotor. Elevation with cryotherapy, anti-edema massage and maintaining the general tone of the limb.
- followed by a period in which a more extensive program was rolled out. The exercises are aimed at restoring the locking mechanism of the knee and active flexion. Crutches are gradually removed, going through a phase of single support. This is followed by removal of the splint, if the patient has one. The postoperative stocking is discontinued.
- between 30-60 days the program aims to build strong thigh muscles. The progression is from open kinetic chain exercises to closed and bodyweight exercises.
- Late postoperative period. Single support stability exercise and balance on unstable platforms. Priometric exercise and the transition to running. Working out elements of specific sports.
