Post-operative Treatment for Anterior Cruciate Ligament Replacement

Patient information:

Post-operative Treatment: Anterior Cruciate Ligament Replacement Surgery

Dear Patient,

For optimal treatment, please provide your physiotherapist with the following post-operative treatment plan:

The cruciate ligament replacement was performed using a tendon graft from the patient’s own body

  • from the semitendinosus tendon (hamstring tendon)
  • from the quadriceps tendon (thigh extensor tendon, middle third)
  • from the patellar ligament (patellar tendon, middle third)
  • Allograft (human donor tendon)

The replacement cruciate ligament was fixed with screws (1) or metal buttons (2) on the femoral condyle and the tibial head.

Tibial head:

Femoral condyle:

Goal of Cruciate Ligament Replacement Surgery

The goal of cruciate ligament replacement surgery is good function and high stability, and regaining full athletic ability after approximately 6-8 months. Our post-operative treatment concept provides a rough timeline and classification. The timeframes may be extended depending on the individual’s progress.

Phase I (1st to 2nd Week):

Goal:

  • Pain relief Reduction of swelling
  • Mobility S 0-0-60 (range of motion from straight extension to right-angled flexion)

Weight-bearing:

  • Walking with foot sole contact Forearm crutches and 4-point brace

Brace treatment:

  • Ice or cooling compression bandage
  • Donjoy brace locked at 0-0-60 during the day
  • Thrombosis stockings

Physical therapy:

  • passive movement two to three times daily
  • active mobilization without significant weight-bearing
  • Lymphatic drainage for severe swelling and isometric passive physical therapy 0-0-60
  • Motor splint 0-0-60
  • Ice

Medication:

  • Thrombosis prophylaxis (Lovenox 40mg once daily)
  • Diclofenac 3x 50 mg daily
  • Gastric protection
  • Sirdalud 2 mg 1×1 in the evening

Phase II (3rd to 6th Week):

Goal:

  • Mobility of the knee joint 0-0-90 3rd & 4th week
  • Mobility of the knee joint 0-0-120 5th & 6th week
  • Full weight-bearing

Weight-bearing:

  • Goal: Full weight-bearing with Donjoy brace

Brace treatment:

  • Donjoy brace locked 0-0-90/120
  • Release of the brace from the 6th week

Physical therapy:

  • Motor splint treatment 0-0-90/120
  • Electrotherapy with iontophoresis
  • Patellar mobilization
  • Mobilization to full extension of the knee joint
  • no hyperextensions
  • Release of any adhesions in the scar area
  • dosed stretching of the hamstring muscles, M. rectus femoris, M. gastrocnemius, M. iliopsoas and Tractus iliotibialis.
  • Cycling with adapted pedal resistance
  • Training on wobble boards, therapy gyroscopes, soft floor mats
  • Stabilization in single-leg stance on different surfaces

Medication:

  • Novalgin 500 mg 3×1 as needed

Phase III (7th to 14th Week):

Goal:

  • Regaining full functionality 7th to 14th week

Weight-bearing:

  • Full weight-bearing allowed
  • Donjoy brace only for heavy loads

Physical therapy:

  • Complex coordination training
  • reactive stabilization training
  • Strength training (closed system) e.g. leg press
  • Reaction training (sidestep, jumps)