The overall rehabilitation plan emphasises the importance of pre-operative exercises followed post operatively by early control of swelling and regaining full extension (straightening) and flexing of the knee (bending). Working on strength can only start once swelling and range of movement have been controlled. Return to function then follows.
Key to Success The key to successful rehabilitation is to regain normal, full straightening of the knee as soon as possible, and to control swelling in the early post operative phase before progressing to strength activities. For the first six weeks, until the new graft is well bedded in and healed in place, exercises are performed gently with the aim of regaining normal bending and straightening as the swelling settles. Repetitive cycling of the knee is restricted during the first 6 weeks as this may overload the fixation of the ligament and lead to slippage of the graft and effective lengthening of the new ligament.
During exercises the foot is initially kept in contact with the ground or with the surface of an exercise machine – these are called ‘closed’ kinetic chain exercises.
Elevation of the leg between exercises to reduce swelling is also important and helps allow the bending to improve.
‘Open’ kinetic chain exercises, where the foot is unsupported, are introduced towards the end of the first six weeks as knee control and strength improves. This allows muscle strength to improve without putting excessive stress on the graft.