ACL Prehab & Procedure?

I have a young sportsman who has ruptured his ACL and is hoping to have a reconstruction in the next 3 – 6 months.

He is normally very active, (Rugby, Squash, Multi Event Races etc etc,,, and is also an ex Royal Marine),,, so asking him to limit and or cut out his normal training program for the next 6 months pre op (with another 6-12 months post op) could prove tuff going both mentally and physically for him.

Current symptoms are: intermittent pain on walking/running (especially downhill’s).

My question:

1. Can anyone offer any advice and or pre-habilitation exercises (along with any other advice or suggestions) in order to strengthen and or support this injury until he has his op?

2. Whilst I appreciate that most surgeons have their own preference for either performing a Patella Tendon rather than a Hamstring graft (or vice versa),,, based on this gentleman’s history, and outlook to return to his physical pursuits ASAP post operatively, can anyone recommend which procedure would best suit his needs?

3. What sort of post op training he will need to perform in order to return to function ASAP post operatively?

4. Finally, due to his desire and dedication to commit to both his prehab and rehab, can anyone offer a realistic timeframe for his return to function post op?

Many thanks in advance

Having gained some experience in this field, the best Post and prehab I can recommend is with a VERY qualified Rehab Pilates instructor. Not only will the pilates equipment be very beneficial to this patient, but the instructors knowledge on pilates style exercises will be of great value.
The amount of limited knee flexion is dependant on the patient and instructors knowledge, client feedback and level of reaction the next day.
The athletic pilates program we provide will keep the client fit in all other areas of the body while we 'isolate' the knee and perform different strengthening/ stabilizing exercises there.
If you are based in Sydney, we can get together and discuss. If not my email is allan@pilates.net

Regards
Allan Menezes

Please Allan, treating the knee in isolation is not appropriate.

I agree Pilates is an excellent option for this client, especially reformer work, but one should look at the lower limb as a chain.

As for the amount of flexion? This is not dependent on instructor knowledge! Instructor knowledge in movement is essential but I have seen very few Pilates instructors with this.. no offense as I am a Pilates teacher with the Pilates Foundation UK. By all means give Pilates a good rap but let's not go overboard

1.Pre-op exercises usually depend on the amount of pain, ROM restriction and frequency of instability episodes. Assuming that you patient has no MCL and/or meniscal injuries with minimal pain and ROM issues, he can work at building the strength of his quadriceps, hamstrings and calves with both open and closed kinetic chain strengthening exercises. Since there is no ACL to speak of, open kinetic chain (OKC) exercises may be used if weight bearing is painful. A common pre-op programme may include 15-30 minutles cycling followed by strengthening exercises. Aqua jogging and swimming may be considered to maintain cardiovascular fitness. Jogging/running may be permitted if pain and instability are not an issue.

2. I do not think the type of graft will determine the time taken to return to sports. It is debatable whehter hamstring or patellar graft is superior over another.

3. Full or near full function as far as ADLs are concerned can be achieved in 4-6 weeks post-op. Most surgeons would be able to provide a post-op ACL rehab protocol of their preference. A good reference text is Clincal Sports Medicine by Brukner & Khan.

4.I think you have already outlined the realistic timeframe for his return to sports (i.e. running, squash and rugby). Although he may be able to return to jogging/running fairly soon, strong acceleration and decelearation type activity such as squash may not be possible for 6 months as the graft may fail. Graft failure is usually a good incentive for most patients to adhere to the programme but there are always exceptions. The general rule of thumb is that one cannot hurry nature.