By Dr. Jared Packer DPT, SFMA, CSCS

Here at Move Strong Physical Therapy, we see a fair amount of clients recovering from ACL reconstruction surgery. We have observed that the rehabilitation process is smoother when the client is educated beforehand. 

This article reviews some ACL surgery recovery tips and post-op exercises for your upcoming ACL reconstruction surgery that will help to keep you safe and prioritize your rehab.

Prehab

Injury prevention is the best medicine when it comes to ACL tears. Patients with a better range of motion and strength going into surgery will regain it afterward. Train safely, normalize your range of motion, and get your leg as strong as you can prior to surgery.

Start Rehabing Immediately After ACL Reconstruction Surgery

We will get into the specifics in a bit, but just know that the rehab process starts right away with ankle pumps, quad sets, icing, elevation, etc. Developing this mindset of active recovery will strengthen your locus of control.

Begin physical therapy within 1 week of ACL reconstruction surgery. Regaining knee extension and quad activation should be prioritized initially, to ensure optimal recovery. Arthrofibrosis can form within 6-12 weeks, which means the formation of scar tissue. Obviously, you do not want this, and It is a lot easier to regain range of motion before this sets in.

Top Health Complications After ACL Surgery

1. Blood Clots

2. Deep Vein Thrombosis

3. Pulmonary Embolism

4. Infection at Incision

These ACL surgery complications are rare but are medical emergencies. You should be aware of their signs and what to do if one of them happens.

Blood Clots

(https://www.health.harvard.edu/heart-disease-overview/deep-vein-thrombosis- overview)

Deep Vein Thrombosis

This is a blood clot in your calf. It can cause damage to the tissues of your leg by blocking blood flow. It can also dislodge and travel to the lungs, causing a pulmonary embolism.

Signs and symptoms:

• Sharp, persisting pain in the calf.

• If you notice this, notify your doctor or report to the ER.

Pulmonary Embolism

When a blood clot is dislodged, travels through your bloodstream, and blocks an artery in your lungs. This can cause damage to your lungs, other organs, and can be life-threatening.

Signs and symptoms:

• Sharp chest pain

• Shortness of breath

• Difficulty breathing

• Go to the ER ASAP if you notice any of these symptoms!

Infection at Incision

Infections can happen if bad bacteria enter the incision site before it is able to scab over during the healing process, and typically presents as excessive draining at the incision site, discolored discharge with or without odor.

Signs and symptoms:

• Fever

• Abnormal discharge

  • yellow/green color

  • unpleasant odor from wound

• Hot to touch

• Excessive redness, tracking marks

• Drainage from your incision at day 6 or beyond

What to do:

• Contact Doctor or go to ER

• If you have a fever, especially when combined with any of the other signs, you should go to the ER ASAP!

Post-ACL Surgery Exercises: 4 important things to work on 

Here are the 4 most important things to work on with post ACL surgery exercises for a fast recovery.

1. Reduce Swelling

2. Regain Knee Extension

3. QuadActivation

4. Reduce Pain

Swelling

Swelling is normal after an injury. Persistent swelling can lead to long term effects on range of motion and functional movement. Reducing swelling will also improve knee extension and quad activation. 

• Elevate leg as much as possible for the first 5 days after surgery.

• Ice 20 mins on/off for the first 48-72 hours post-op. 

• After the initial 2-3 days period, continue icing if you find that it reduces pain. There is solid research supporting its use for reducing pain. Less pain can mean less swelling, and decreased muscle guarding.

• E-stim (lower intensity rhythmic contractions, e.g. Marc Pro).

Our muscular system acts as a pump for the lymphatic system. This helps to move fluid around in our bodies and to clear out areas where fluid and waste accumulates. 

Using something like a Marc Pro stimulates the muscles around the knee joint to have low intensity, rhythmic contractions. This acts as a pump and does not fatigue the muscles.

Active Range of Motion: Heel slides, Ankle pumps

• Again, our muscle acts like a pump to get the fluid out. For this post-ACL surgery exercise, I recommend my clients to do lots of reps. For heel slides, start with 10 at a time, 100 throughout the day. Work up to 50 at a time, 500 throughout the day.

• Knee doing this until the swelling is down and the knee range of motion is normalized.

• If a hamstring graft was used, make sure your heel can slide easily, and you are pulling with the front of your hip more than the back of your leg.

Minimize time standing/walking for the first week

• For the first week after an ACL Surgery, it’s best to minimize standing and walking. If you can stand/walk with the brace locked into extension and crutches for 5-10 minutes, by all means, do it, but pay attention to any swelling that happens as a result. Know where your limit is, and try not to cross it during the initial healing phases.

Regain Knee Extension

If you can’t straighten your knee all the way, it will alter your walking and running patterns. It is crucial to work on this during the early phases of rehab when it is easiest to regain. Ideally, you want your knee to extend/hyperextend as much as the other leg as soon as possible.

Reduce Swelling

• The swelling will cause tissues surrounding the joint to tighten and restrict ROM. In addition, the fluid buildup will block the joint from moving fully.

Prop your heel up on a chair, ottoman, or couch armrest.

• With this exercise, incrementally position the leg so that you are stretching it into a straightened position, max of 4/10 intensity. Start with 5 minutes at a time and progressively build to 15. Work up to 30-45 minutes a day.

• Restoring Knee Flexion back after ACL surgery is important as well, but takes time, and is not as important as an extension for the early phase of recovery.

Regain Quad Activation

Quad strength is needed to stabilize the knee when walking. Some studies have shown that reduced quad strength in the recovered leg relative to the non-surgical leg correlates with an increased rate of knee re-injury over the next 2 years.

Reduce swelling

• The swelling of the knee joint inhibits quad activation.

Regain Full ROM

• Limited knee extension inhibits quad activation. This is a protective response from your brain.

Quad sets

• Squeeze quad for 10 seconds, for 10 reps. Repeat 10 times throughout the day.

Use e-stim (russian stim)

• This is different from the Marc Pro style mentioned before. It produces a sustained contraction of the quadriceps which you voluntarily contribute to. It has been shown to increase quad strength and size after ACL surgery. Use this along with your quad sets for at least the first 4 weeks post-surgery.

Reduce Pain

• Some discomfort is normal during the recovery process, but generally, you don’t want to push yourself through the pain. This is especially true in the beginning phases, to avoid the swelling/pain cycle.

• Along the same lines, give yourself a chance to heal. Especially for the first 1-2 weeks, try not to spend an excessive amount of time on your feet. If you notice increased swelling after an activity, you are doing too much.

• Using a nerve block can reduce post-operative pain. There are some studies that have found impaired quadriceps strength in the immediate and intermediate post-op periods, so there is potentially a trade-off. Ultimately this is a conversation you should have with your surgeon, to be educated on the pros and cons.

Keep these 4 priorities for your  ACL reconstruction surgery at the forefront of your attention during the early phases of healing, and you will reap the benefits of a faster recovery.

Ultimately recovery from ACL Reconstructive surgery is optimized with Physical Therapy exercises. For more ACL surgery recovery tips, you can contact our team - we are happy to answer your questions.

To learn more about Move Strong Physical Therapy in Hudson, MA, visit our About Us page.