After ACL surgery I'm scheduled to work with the physical therapist 3 times a week. Is this necessary?

Q: I had ACL surgery two weeks ago. The physiotherapist was there right after the operation getting me up and going. The next day, she set me up on a home program and I go see her 3 times a week. It seems like a lot of work. Is this kind of rehab really necessary? Won't the knee just heal and get better on its own?

A: There are many different ways to approach the rehabilitation of ACL injuries. Sometimes it is possible to complete a conservative plan of exercise without surgery. This approach is most likely for the less active individual or the patient who did not completely rupture the ligament.

Most of the time, when there is a complete rupture, then surgery to reconstruct the knee is necessary. Active participants in sports and especially those players with a complete ACL rupture will definitely require surgery to reconstruct the ligament.

Graft tissue taken from the patellar or hamstring tendons is used to replace the destroyed ligament. Rigorous rehab is always important after surgery. The goals are to regain motion, strength, and balance. Athletes have the additional goal of eventually returning to full level of sports play.

Studies show that early, aggressive rehab can be started right away during the recovery process. This is referred to as accelerated rehabilitation. Early, aggressive therapy is safe and may restore strength faster. This type of approach includes immediate post-op weight-bearing (standing and walking) and range-of-motion exercises.

Muscle strengthening is an essential part of the post-operative rehab program. Eccentric quadriceps strengthening and isokinetic hamstring strengthening can be started three weeks after surgery. So you have that to look forward to next week. The more you do at home following the physiotherapist's instructions, the faster your recovery will be.

Even with early, aggressive rehab, you can expect a six-month recovery time minimum. Most people who are consistent with their program actually need up to a year to fully recover. You may not be an athlete in need of a quick turn around time. But anyone who has had ACL surgery is at risk for reinjury if the knee is not retrained.

Reference: L.M. Kruse, MD, et al. Rehabilitation After Anterior Cruciate Ligament Reconstruction. In The Journal of Bone and Joint Surgery. October 3, 2012. Vol. 94A. No. 19. Pp. 1737-1748.

Cambie Physiotherapy and Health Clinic provides services for physiotherapy in Richmond.

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