ACL重建术后康复程序.doc

Preoperative ? ? Reduce swelling Regain full extension unless restricted by bucket handle meniscal tear Increase flexion to maximum that is comfortable Regain adequate Quadriceps Hamstring strength by closed chain exercises No pivoting sport ? ? Postoperative Discharge- Same day in the vast majority of patients Pain control is achieved by using infiltration of local anaesthetic in to the joint and wound plus use of a nerve block Discharge from Hospital goals Mobilising safely with crutches including doing stairs Passive full extension and reasonable flexion (60-90 degrees) Outpatient physiotherapy appointment organised Goals for 0-2 weeks Mobilise with the aid of crutches including indoors Reduce bandage after 24-48 hours Pain relief Reduce swelling- Icing 4-6 times daily 15 minutes each time Regain extension- heel raise and extension stretch, quadriceps bracing exercise Regain flexion beyond 90 degrees Mobilise patella (Patella tendon graft) and no active hamstring curls (Hamstring graft) Goals for 2-6 weeks Note: The graft does not heal in the tunnels for at least 6-8 weeks Wean off crutches Regain symmetrical hyper extension- heel raise, prone hangs (compare heel height) Regain full flexion by heel slide using a towel (compare heel-buttock distance) Mini squats. Bridging exercises Proprioceptive exercises and improve joint position sense Closed chain exercises- Exercise bike No driving for 2-3 weeks for left knee and 4-6 weeks for right knee 6 weeks to 3 months Closed chain exercises and straight line activities only Gait training, core strength and balance training Improve quadriceps and hamstring strength- exercise bike, cross trainer, Lunges, single leg dips Low resistance and low weights but more repetition Brisk walking, Swimming 3- 6 months More intensive strength training Open chain exercises allowed Start running on a treadmill Regain atleast 80% quadriceps and hamstring strength compared to opposite leg Progress to shuttle runs, side stepping, diagona