Yorkshire Knee Surgery - Mr A Siddiqui Consultant Knee Surgeon
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Knee/ACL Rehab & Exercise

ACL & Knee Rehabilitation and Post Operative Care

  • After the operation (ACL reconstruction), the knee will be in a bandage
  • Overnight stay in hospital is the norm after the procedure
  • The first 2 weeks are spent with crutch assistance while walking
  • The most important movement to work on is regaining full straightening and extension of the knee to equal that on the other un-operated knee. There is normally a degree of hyperextension naturally present in knee joints, which should be targeted and restored. This should be achieved in the first 2 weeks.
  • Swelling control is achieved with ice when the knee is swollen, and resting when swelling commences during your exercises. As swelling reduces, bending the knee becomes easier. Most people have regained all knee movement by weeks 4-6.
  • Your surgeon will usually review you in the clinic in this early phase of 2-4 weeks.
  • Driving is usually safe at 4 weeks after your operation
  • Return to work varies but a rough guide is as follows: 4-6 weeks for desk jobs, 6-8 weeks for light/heavy manual jobs, 8-12 weeks for heavy jobs with ladders and heights.
  • Building up muscle strength is a gradual and progressive activity that starts before the operation and carries on for months after. Your physiotherapist will instruct you clearly and assess you at stages and tailor your exercises according to your progress.
  • At 6 months you will have a further review and assessment of your knee. You may have an Xray and some tests to assess stability of your knee on this visit along with outcome scores. Some patients are deemed fit to return to sports at this point but others need a bit more time before they are deemed fit, but usually have returned to sports by 9 months. Rarely it may take a year. Further appointments after this point are based on the progress up until this point.

The following is an ACL post op physio regime used by Mr Siddiqui, and also serves as a general rehabilitation program following knee injury.

 

X = Do these exercises in these weeks

? = Only do this exercise if needed



 

Exercise

 

Rep

 

Wk 1-3

 

Wk 4-6

 

Wk 7-9

 

Wk 10-12

 

Wk 13-15

 

Static Quads

 

10-30

 

X

 

 

 

 

 

 

 

 

 

Static Hams

 

10-30

 

X

 

 

 

 

 

 

 

 

 

Hyperextension

 

10mins

 

X

 

X

 

?

 

 

 

 

 

Heel slides & Wall slides

 

10-30

 

X

 

 

 

 

 

 

 

 

 

Straight Leg Raises

 

10-30

 

X

 

X

 

 

 

 

 

 

 

Mini squats (X=double leg) (SL=single leg)

 

10-30

 

X

 

SL

 

 

 

 

 

 

 

Calf raises (X=double leg) (SL=single leg)

 

10-30

 

X

 

 

 

 

 

SL

 

 

 

Hamstring curls & flicks

 

10-30

 

X

 

X

 

X

 

X

 

 

 

Balance

 

1min x 5 

 

X

 

X

 

X

 

X

 

X

 

Dips

 

10-30

 

 

 

X

 

X

 

X

 

 

 

Step-ups

 

20-50

 

 

 

X

 

 

 

 

 

 

 

Stretches

 

1min x 10

 

 

 

 

 

X

 

X

 

 

 

Skipping

 

5mins

 

 

 

 

 

X

 

X

 

 

 

Squats (X=double leg) (SL=single leg)

 

10-30

 

 

 

 

 

X

 

SL

 

 

 

Jumping

 

5mins

 

 

 

 

 

 

 

 

 

X

 

Hopping

 

5mins

 

 

 

 

 

 

 

 

 

X

 

Bounding

 

5mins

 

 

 

 

 

 

 

 

 

X

 

Figure 8s

 

5mins

 

 

 

 

 

 

 

 

 

X

 

Static cycle

 

10-20min

 

X

 

X

 

X

 

X

 

 

 

Gym: cross trainer, treadmill, rower

 

10-20min

 

 

 

X

 

X

 

X

 

X

 

Trampet/Wobble : walking, jumping, running

 

 

 

 

 

 

 

X

 

X

 

X

 

Swimming:crawl

 

 

 

 

 

 

 

X

 

X

 

 

 

Leg Press & Abduction

 

10-30

 

 

 

 

 

X

 

X

 

 

 

Jogging

 

10-20min

 

 

 

 

 

 

 

 

 

X

 




 

Static Quads: Sitting, push knee down into bed

 

Static Hams: Sitting with knee bent, dig heel into bed

 

Hyperextension: Resting with heel on towel

 

Heel Slides and wall slides: Sliding knee as far bent as possible. Can lie on floor with legs above your head resting against a wall, and if socks worn, heel will slide down a smooth wall with ease and gravity can assist.

 

Straight leg raises: Sitting, brace knee and lift whole leg off the bed

 

Mini squat: Standing with feet hip width apart, squat small way only. Go onto one leg after week 3

 

Calf raises: Standing with feet hip width apart and raise up onto toes (double/single leg)

 

Hamstring curls & flicks: Lying on tummy and curl leg up so that knee bends. Sudden movements are flicks. Can add resistance and weights after week 4

 

Balance: Standing on one leg. Progress to doing with eyes closed, and finally on uneven surfaces such as pillows or mattress.

 

 

Dips: Stand on step sideways on and dip down so that toes touch the floor. Increase height of step after week 6

 

Step-ups: stand facing a step and step up and down onto it

 

Stretches: Touch toes for hamstrings and calf. Pull leg up and bend knee fully while standing to stretch quads.

 

Skipping: Use a rope, or mimic a rope. No high jumping, just clear the rope with tiny jumps and hops.

 

Squats: Stand with back on a ball against a wall and squat (double/single leg)

 

 

 

Jumping: On the spot and jumping on the move going forwards then backwards

 

Hopping: On the spot then in different directions

 

Bounding: Leaping as far as you can in a line

 

Figure 8s: Run in a figure of 8 pattern with smooth direction change

 

 

 

Static cycle (Exercise bike): gauge according to knee bend and start slow on low resistance setting, building up with time

 

Gym: Spend 10-20 mins on low resistance/incline settings on the cross trainer, treadmill, and rowing machines. Remain at a calm walking pace only until week 12. Jogging can commence after this point.

 

Trampet and Wobble Boards: Aids balance and uneven surface control. Spend 5-10 mins if accessible

 

 

Leg press & Abduction: Use theraband around foot, or gym equipment

 

Swimming: Do crawl (front or back) only  

 

Jogging: On a treadmill or outdoors. No sprinting, increase distance gradually

 

 

 

After week 15, continue exercises incorporating all the exercises you have done until this point but gradually building your endurance.