Contralateral ACL reconstruction

WIth contralateral ACL reconstruction surgery , the rehabilitation is split between the two knees so allowing each knee to have to only concentrate on one goal which can be done simultaneously .

* The ACL reconstructed knee only has to regain motion (with swelling control) initially
* The graft or donor knee only has to regain strength. 

This is distinctly different to ipsilateral ACL reconstruction , where the one knee has to regain both motion and strength. These are conflicting goals as strengthening early on causes the knee to swell. So with ipsilateral surgery, the goals have to be achieved sequentially , meaning the rehabilitation will take longer.

The rehabilitation for contralateral ACL reconstruction is as follows.

ACL Reconstructed knee:

The rehabilitation for the ACL reconstructed leg is the same as the ipsilateral ACL reconstruction rehabilitation . The aim for the ACL reconstructed leg for the first 3-4 weeks is simply to get the swelling down and to get motion back.

Donor/harvest knee:

The main emphasis in the early stages (1st 4 weeks post-op) of the contralateral graft ACL reconstruction is to stimulate the DONOR/ HARVEST SITE to re-grow and to stimulate the patella tendon defect to heal and allow the bone block harvest sites to fill in and heal.

The donor leg is the one that requires the emphasis on strength.   Also an ice pack should be used regularly throughout the day to minimise any swelling.

Swelling should not be too much of a problem, as Mr. Jari will not disturb the joint of the donor leg in this procedure.

Strength programme for DONOR/ HARVESTED LEG.

·        DAY 0 -1    Double Black Theraband - Knee extensions in supine/long sitting.        50 reps, 2 hourly.

·        DAY 2 -3    Grey Theraband - Knee extensions in supine/long sitting.   50 reps, 2 hourly.

·        DAY 4 -5    Double Grey Theraband - Knee extensions in supine/ long sitting.       50 reps, 2 hourly.

·        Day 6 - Physio Out-patient appoinment.   Double Grey and black. (SingleBlack to start and then progress to double when the exercise feels too easy). 

Knee extensions in supine/ long sitting. 50 reps, 2 hourly.

Week 2 & 3

·        Progress resisted theraband work form double grey + black to double grey +double black 2 hourly if not already doing this at one week post op.

·        Once achieving full resistance theraband work progress to leg press. 

Set resistance according to patient's maximum weight they can press comfortably for 50 reps.   Increase resistance once the patient is able to maintain 50 reps at set limits.

·        Step downs, 50 reps.     LOW }     MED }         STEP      HIGH          }

·        Single leg dips, 50 reps

·        Single leg balance / proprioception work.

·        Static bike.   Start on low resistance to protect grafted leg.

·        Swimming - front crawl legs.

FREQUENCY OF EXERCISES TO BE DETERMINED BY PHYSIOTHERAPIST DEPENDING ON PATIENT'S PROGRESS.

Week 4 - 6

Progress resistance work.   For example:-

- weight on leg press.

- height of step.

-  sets of step downs / leg dips.

-   resistance on bike.

At 6 weeks progress strengthening work of both legs, providing the patient has regained equal range of motion and the effusion has settled on the grafted leg.

Patients can attend the ALC from 6 weeks.   Both legs should be rehabilitated in the class and they should begin speed agility work at 8 weeks or as physiotherapist feels appropriate.

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