Hip and Knee
pin1 Duke St Campsie 2194
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                                                                                  Anterior Cruciate Ligament (ACL) Reconstruction

anteriorcruciateligamentThe aim of surgery is to replace the torn ligament with a graft, which acts as a substitute ligament. The patellar or hamstring tendons are often used for this purpose. The procedure is carried out arthroscopically and the graft is fixed within the knee in the same position as the old ACL. Holes are drilled into the femur and tibia and the graft held in place at each end using a combination of screw, staple and an endobutton. 

The graft requires protection whilst it undergoes revascularization and incorporation. This takes 3 months with the graft being most weak between 6-12 weeks post-operatively. Your rehabilitation has been designed to restore knee function without risking graft failure.


Postoperative Protocol

After knee ligament reconstructive surgery it is very important to regain knee joint movement and thigh muscle tone. The following programme has been devised to achieve these objectives.

Operation Date

Surgery is performed and the knee may occasionally be immobilised in a lightweight brace. A femoral nerve block is given to provide post-operative pain control. You are discharged from hospital the following day.

Day 1 – 14 post-op

Control pain and swelling with elevation and ice
Exercises are commenced.
-ROM – 10-90 degrees 
-Hamstring contractions
-Hamstring and quadriceps co-contractions at 60 and 90 degrees
-Crutches: weight bearing as tolerated
   2 –6 Weeks post-op

Post-operative visit and removal of sutures
Increase ROM
Increase Weight bearing – wean from crutches. 
Hamstring and quadriceps strengthening
-Closed chain exercises / Quarter squats / Isometrics – progress to concentric and eccentric repetitions.
Hip and ankle exercises
Pool work – straight leg kicks
No Running
6-12 Weeks post-op 

Should have full knee movement
Walking unaided 
Stationary bike / Swimming – no breast stroke
Closed chain exercises / half squats / step ups and step downs
Hamstring curls
Gait re-education / Balance and proprioceptive exercises

  3 to 6 months post-op

Regaining of strength
-half squats with resistance / leg presses / leg curls / wall squats
-loaded isometrics
-continue isotonic and stretching exercises
Progressive running programme
-jog in straight line / increase to figure 8
-No pivoting, sidestepping or hopping
Road cycling may commence
Sports specific and agility exercises
Low impact aerobic and step classes
Gym programme
Pool work with flippers
After 6 months postop

Open chain leg extensions for quadriceps
Cardio vascular fitness work
Half speed running – progress to full speed
Stop start running
Cutting – start at half speed and increase
Jumping
Return to training / Sports specific skills
Limited practice sessions and progress to full game 
   
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lk-imageDr. Leonard kuo
(MBBS Syd Univ)
(FRACS Orth)
(FAOrthA)

Dr Leonard Kuo has been in private Orthopaedic practice since 1995 and specialises in surgery of the hip, knee and shoulder. His particular interests are joint replacement arthroscopic treatment of rotator cuff tears, shoulder instability and sports knee injuries. He provides a general paediatric orthopaedic service with subspecialty care in congenital limb deficiencies.