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- The factors that a patient has control,
or that they can control the success of their surgery
is preoperative strengthening and adherence to
a rigorous therapy program post operatively.
They have to be committed to therapy.
They will be weaker after surgery and that
strength will not come back magically.
They have to work hard at it.
(loud stamp thump)
- The main goals of physical therapy following an ACL repair
are primarily, first and foremost, are to get the extension
back in the knee.
That which is art, what we call the ability to straighten
out the knee.
We have a four to six week window for that
before scar tissue forms and that becomes a trouble point,
so if we can get that right away, which usually
is not a problem, then we're in really good shape.
Then after that it's trying to get the range of motion
or the bending of the knee.
Getting the swelling down and then getting the person
to walk with a normal walking pattern
cause even though it seems common and easy,
that's one of the biggest challenge.
People will say, well I have to teach myself
how to walk again.
You know, this is crazy, but it is the number one thing
we have to get into.
After that, then we progress into strengthening, obviously,
and then working on balance and return to activity,
whether it's sports or work or just day to day life.
Ideally, you like to get as much of the motion back
in the first two to three weeks, especially extension.
You have a four to six week window
where you can get the straightening.
If you don't at that point your body starts to build up
enough scar tissue that that becomes difficult
and extension's the number one priority in post ACL
because if you get that, you can get a normalize walking.
You can get the quad to contract well,
so it works out really well that way.
Okay, so one of the key things we need to work with on you
is balance now because as we talked about before
when the ACL is torn, the balance fibers leave with it,
so now when we get the graft in, we're trying to retrain you
how to balance again.
Okay, the first thing you're gonna do is just balance
simply on the one leg. Okay, so go ahead and balance.
Knee flex.
Your job is to keep your knee lined up over your toe
just like that. Okay and control it.
Stay up tall and stomach strong, okay.
Second thing you're gonna need to do is reach.
Just kick back and forth like you're kicking a soccer ball.
One of the key things in regards to ACL we have is
working on proprioception.
Proprioception is a fancy term for balance.
Your ACL has proprioceptive fibers on it,
which help tell the body where the knee is in space
and so when it's torn, those fibers get torn with it.
So when they put in the new graft,
we're trying to retrain the body how to identify
where the knee is with certain dynamic movements,
such as, balancing on one foot.
Something as simple as balancing on that one foot
while you go to lift up a child.
Balancing on that one foot
while you go to kick a soccer ball.
More dynamic activity with athletics.
So we try to build a progression for that.
At a higher level, when you're going to return someone
back to sports or a higher energy job that requires
a lot of physical activity, the next thing we work on
is movement and mechanics.
Teaching people how to plant and pivot effectively
without favoring that leg, but in a way that's gonna keep
the leg safe.
We teach them how to land properly.
Landing with the knees bent and flex and then I'm balanced.
So we do a lot of drills to try to work them toward that
from very benign and basic
just jumping and landing correctly to more functional
ones where they're actually performing an act of movement
within their sport.
One of the nice things about being in Coordinated Health
is our physicians will send over what we call
surgical map with their patients
that allows us when we first evaluate the patients
to see what was actually done in the surgery.
In addition to ACL, did the patient have any meniscus tears
or cartilage damage that may slow or change how we
address the progress from there.
And again, we also will also look at using golden rods,
which is what we call our physician communication
which are letters over to the physician to let them know
how the patient is doing in therapy.
First of all, in the first six to eight weeks,
we're looking actually for the bone to fill in
around the graft,
so they get their fixation in (mumbles) position.
Secondly, then we're looking for the blood supply
to the graft because the graft wasn't originally
in that place in the beginning,
so it's gotta get a blood flow to it in that position.
So, those are all key components for us
to allow someone to return to sports.
Obviously, our side of it's nice in that we worry about
strength and balance and most things you can visually see.
The hard thing I think for most patients is that they can't
see that on their part and that's the key things for us
because even if the strength that those other parts
aren't in place that graft will fail and that's obviously
what we don't want.
We want this to be a one time thing and that's it.
(loud stamp thump)
- An ACL tear is unexpected and sees an ending.
Your recovery process can take six months to a year
depending on your sport or activity level.
Now, while it may end your season, it does not have to end
your career.
There are several steps that you can take to protect
your repair and prevent re-tears in the future.
Once you complete rehab after this ACL reconstruction,
and you resume your normal activities,
it's important to use what we call a functional ACL brace.
This brace will help support the knee and provide a little
additional stability as you resume your work activities,
as you go back to sport.
Continue to perform those stretching
and strengthening exercises, and gradually
resume your normal activities.
Take it little at a time.
After you finish physical therapy,
I think you should start a sport specific training program.
This can jump start your transition back to your sport
and try to get you back to that previous competitive
level as quickly as possible.
You've gotta work consistently on your strength,
your agility, and your balance.
And this will help you regain
that full function of your knee.
And that's the Art of Medicine.
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