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
Bracing
Reasonable to use brace for 2 years post ACL reconstruction
