ACL Solutions - Rehabilitation

Phase IV: 6 weeks after surgery.

During this phase you will work on building your strength back while allowing the ligament to heal into the bone tunnels in your femur and tibia. Most physical therapists prescribe closed-chain kinetic exercises during this phase. In this type of exercise, your foot is planted on the floor and is not free to move about. Squats are an example of a closed-chain kinetic exercise whereas quadriceps extension exercises on a weight training machine are an open-chain exercise. Most surgeons will wait until at least three months have passed before allowing their patients to return to agility training exercises. When to return to competitive or recreational sports after an ACL reconstruction is a difficult decision.

Strength Training In these two pictures, open-chain kinetic exercises are being performed. On the knee extension and hamstring curl machines, the foot is not firmly planted on the floor. A factor that may affect the way in which the knee moves through its range of motion. These types of exercise may put more strain on a reconstructed ACL and are often avoided during the rehabilitation period.

In contrast, during the squat type of exercise, the foot is firmly planted on the floor and does not move. This allows the body to control the motion of the knee more precisely, a factor that may also decrease the amount of strain placed on the new ACL graft.

Many people find squatting exercises difficult, especially if they do not have a physical therapist or a partner to train with. Fortunately, there are several different strength training machines that will allow you to perform these types of exercises. The squat deck permits you to vary the amount of weight that you press with your legs. It is a very good exercise machine for keeping your quadriceps strong after surgery. It is important to note that in both of these quadriceps exercises, the goal is not to put your knee through a full range of motion. Instead, you should perform "short-arc" exercises where you only bend your knees to the degree shown in these pictures.

The timing of your return to normal athletic activities will depend upon how well you have done with your rehabilitation, how solid your knee feels to you, and what you and your surgeon decide is reasonable. Even after you return to your activities, it is important that you pay special attention to keeping your quadriceps and hamstrings in good shape, as this is considered an essential part of protecting the ACL.