10 Things to consider before you have surgery.
1. Talk to different orthopedic surgeons and do your homework since each physician will have their preference on what type of graft to use which may not be your best option based on your age and activity level.
2. There is no gold standard yet for the type of replacement ligament to use: Allograft versus Autograft. Allograft is tissue that comes from a cadaver and rehab is often faster since you don’t need to worry about the harvest site to heal. An autograft is harvested from the patient’s own tissue, usually the hamstring or quadriceps tendon. The rehab can be a bit longer as the harvest site heals, but some studies have shown that allografts have a higher failure rate than autografts.
3. Start to rehab even before surgery. The stronger you are going in and the better range of motion you have, the better the outcome will be.
4. You may want to wait to have surgery if you still have a large amount of swelling in your knee.
5. Use crutches when you are allowed to start weight bearing on your knee, but do not have a normal gait pattern yet. You do not want to stress another part of your body with a prolonged limp.
6. Regain quadriceps control ASAP by first doing isometric contractions, then straight leg raises (probably with brace locked in full extension). Quadriceps “amnesia” is common after ACL surgery.
7. Follow your surgeons rehab protocol to minimize chance of re-injury.
8. The knee does not exist in isolation; it is very dependent on the hip and ankle for normal motion. Make sure you have normal mobility of your hip and ankle on both sides, especially the injured side. At the hip, make sure you have good internal rotation and adduction ability (ability to cross midline, no excessive ITB tightness). At the ankle, you must regain full dorsiflexion (ability to bend your ankle up).
9. Re-establish the “minor” motions of tibial internal and external rotation (this is the Screw home mechanism of the knee) and proper fibular motion (for reducing ground reaction forces).
10. Before you return to your sport, make sure you have regained muscle girth (circumferential thigh measurements must be >90 % of uninjured side), normal single leg balance as indicated by the “Star Excursion Balance Test”, test the power on each leg with the “Single leg Hop Test” and train the “landing” by working on eccentric exercises as many injuries occur with landing the jump.
Please let me know if you have any questions,
~Ed Deboo, PT Integrative Physical Therapy, Bellingham, WA