ACL Reconstruction Protocol

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Introduction:

This surgical procedure has a lengthy rehabilitation process and we at the Jerusalem Sports Medical Institute recommend that the process begins approximately two months before the actual surgery date. This includes an intensive strengthening and neuromuscular- sensory program in order to ensure  that the injured limb, as well as the athlete as a whole, will approach the surgery in the best physical shape as possible. Detailed explanations and demonstrations are provided to the athlete regarding the surgical procedure, the preparation pre and post- surgery, as well as the rehabilitation process and the return to sport criteria.

 

Post Surgery:

We strongly recommend that the athlete begins the rehabilitation process as soon after the surgical procedure as possible, always considering the amount of pain and swelling that may exist in and around the knee. If possible, we begin the rehabilitation three days post -surgery and apart from modalities to reduce pain and swelling, rehabilitation begins with the Smartstep™ biofeedback system in order to achieve full weight bearing as soon as possible. The next week to 10 days continues with an exercise program highlighting range of movement and strengthening and utilizing high intensity electrical muscle stimulation as an adjunct in the therapy. By approximately the fifth meeting, the athlete should be fully weight bearing, have full extension of the knee and be well versed in the rehabilitation process. The athlete will then continue rehabilitation independently for the next 4-5 weeks.  In order to provide personal care during the whole process and reduce costs significantly, the athlete is strongly encouraged to join a sports center for a 6- month period.

At six weeks: the athlete once again meets with the rehabilitation team and the following an examination, a more advanced program is commenced for another 6 weeks (see pics below)     

 

At 3 months:

Once again the program is adjusted for the next 3 months. This includes more challenging activities, including jogging, jumping and pivoting- type exercises in addition to more advanced strengthening and neuromuscular sensory balance training (pics below)

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Final Discharge Meeting: (>9 months)

Grindem et al et al in 2016 have shown that the reinjury rate was significantly reduced by 51% for each month RTS was delayed until 9 months after surgery, after which no further risk reduction was observed. Using these simple rules, they calculated that it is possible to reduce the second injury by 84%.  This new information provides for the first time, clear evidence that the RTS decision following ACLR, should be preferably delayed from the current 4-6 month period, to at least 9 months post surgery. Prior to discharge, a battery of performance and functional tests are done incuding the single hop test for distance, the cross over hop test for distance, the triple hop for distance, the 6-metre timed hop test, the drop jump, side hop test and vertical hop test. Only if the athlete completes all these tests with at least 90% success compared to the uninjured side, will he/she be discharged. 

 

On average, there are a total of 6-9 meetings over the 6 month period.