Rupturing or tearing one's anterior cruciate ligament (ACL) can be a painful and debilitating injury, especially if the patient is highly-active or an athlete. Multiple tissue graft options are available to repair the torn ACL, including harvesting a hamstring graft from the patient's affected leg. Rehabilitation protocol to help the patient recover from this procedure will focus on strengthening the leg and maintaining flexibility in the joint.
Beginning Considerations for Hamstring Graft Allocation
At the beginning of therapy, the physical therapist will need to establish clear and concise treatment expectations with the patient. For example, the new ACL constructed from the patient's hamstring graft will take up to 8 weeks before coming completely vascularized and can therefore be rather weak leading up to that point. Therapy sessions will begin the day following surgery and can continue for up to 6 months.
Early Therapy Focuses On Minimal Movement
Phase one of ACL rehabilitation therapy begins with a focus on protecting the hamstring graft within the knee joint via immobilization and manual massage techniques. Passive knee flexion to 90 degrees is also implemented during this time with assistance from the therapist. Weight-bearing exercises will be introduced as tolerated by the patient for up to 4 weeks following surgery. Walking and gait re-education is started only after the patient is able to fully support his weight on both legs.
Phase Two Focuses On Full Extension of the Knee
After the fourth week of therapy, the patient and therapist will focus on regaining full range-of-motion (ROM) in the knee from an extension perspective while keeping knee flexion maximum set at 90 degrees. Gait and normal walking is reintroduced during this phase of treatment either with or without assistance from the therapist. Minor exercises such as toe raises and hamstring stretches are continued throughout this phase and into week six of therapy.
Phase Three Treatment Introduces Full ROM for the Patient
After the sixth week of therapy the patient should have full ROM within the knee joint in both flexion and extension positions. Strength training and continued stretching is incorporated within this stage of treatment and can include treadmill or elliptical training. Pain or discomfort may still exist in the knee joint during this stage, however this level should be minor in comparison to what was felt immediately following surgery.
Final Phases Include Pain-Free Movement and Weight-Bearing
During the final weeks of therapy, the patient will exhibit full ROM without any pain. She will also be able to return to full weight-bearing status with no instability or discomfort. Athletic activity enjoyed prior to injury will be reintroduced to the patient at the end of therapy.
Upon the time of discharge from therapy, the physical therapist will prescribe a home workout or exercise program to the patient for continued strengthening of the affected leg and knee joint. A knee brace may be worn by the patient during athletic activity for added support and stabilization within the joint.
Source:
- Massachusetts General Hospital; "ACL Reconstruction Using Hamstring Tendons Protocol"; Thomas F. Holovacs, MD; accessed May 10, 2011.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice
Adam Fonseca - Adam Fonseca is a certified Lean Six Sigma Change Agent and an accomplished golf writer. He currently works in health care ...
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