Rehabiliation

Concept Accelerated Rehabilitation

 

Shelbourne 1995

- noticed patients noncompliant with their rehab protocol were doing much better

- looked at what noncompliant patients were doing

- what they were doing was advancing activities as tolerated

 

Reviewed results of accelerated rehabilitation

- fewer ruptures with better ROM

 

Major recommendations

 

1.  Previously patients splinted in flex often in POP

- now splint in extension

- aggressive early ROM concentrating on regaining extension

 

2.  Previously prolonged NWB

- now FWB immediately with crutches

 

3.  No acute operations

- only after rehab & out of inflammatory phase

- decrease in MUA rate 10% to 0.5% 

- decrease in scar resections 19% to 1%

 

Key Points of Accelerated Program

 

1.  Post op ROM +++

- including prone hyper-extension

 

2.  Early FWB once quadriceps control 

- PWB on crutches till then

 

3.  Early functional activity

- regain full ROM

- muscle strengthening +++

- swim / cycle 3/12

- straight line jog 4/12

 

4. Gradual return to sport 

- training 5/12

- contact sport 6/12 - 9/12 - 12/12

 

Shelbourne 4 Stages

 

1.  Pre-Operative

 

Aim

- Regain full ROM

 

Mechanism

- resolve swelling

- normal gait

 

2. Acute Phase 0-2 weeks post operative

 

Aim

- obtain full ROM

 

Mechanism

 

A.  Obtain full hyperextension 

- wall slides, heel slides, prone hyperextension

 

B.  Achieve 100° flex

- decrease swelling

 

Start next phase when full hyperextension with minimal swelling and good leg control

 

3.  Recovery Phase 3 - 6 weeks

 

Aim

- resume normal gait and range

- obtain full flexion

 

Mechanisms

- co-contractions / closed chain exercises

- increased knee bends, step-ups, calf raises, leg press, stairmaster, cycle

- begin sport specific activities

 

Ends when ROM +5°-135° & resumed normal activities

 

4. Functional Phase > 6 weeks 

 

Aim

- return to sport

 

Mechanisms

- closed kinetic chain strengthening 

- joint compressed & stable

- less ACL stress than open chain

 

Swelling & pain

– sign that going too fast

- need rest

 

5.  Return to sport

 

Timing

 

Minimum 6 months

 

Guidelines

 

A.  No effusion

B.  Stable knee

C.  Good strength

- 80% other side for athlete

- 90% other side for non athlete

 

ACL Return to Sport Power Testing

 

Bracing

 

Reasonable to use brace for 2 years post ACL reconstruction

 

ACL Brace Donjoy Defiance