Beruflich Dokumente
Kultur Dokumente
eral Informa
ation: The fo
ollowing ACL rehabilitation guideline
es
Gene
are ba
ased on a re
eview of the randomized
d controlled trials
t
related
d to
ACL rehabilitation
r
n. For manyy aspects of ACL rehabillitation there
e are
eitherr no studies that qualify as
a best-evid
dence or the number off
studie
es is too few
w for conclusions to be drawn with co
onfidence. In
these
e circumstances, the reco
ommendatio
ons are base
ed upon the
guida
ance of the MOON
M
panel of content experts.
e
g
ha
ave been de
eveloped to service
s
the spectrum
s
of ACL
A
The guidelines
injure
ed people (no
on-athlete elite athlette). For this reason,
exam
mple exercis
ses are provided instead
d of a highly structured
rehab
bilitation prog
gram. Atten
nding rehab
bilitation specialists sh
hould
tailorr the progra
am to each patients
p
sp
pecific need
ds.
The multicenter
m
n
nature
of the MOON grou
up necessita
ates that the
e
MOON ACL Reha
abilitation Prrogram only include trea
atment methods
that can
c be emplo
oyed at all sites without purchasing expensive
equip
pment. Conssequently, so
ome treatme
ent methodss with supporrting
evidence (e.g. using a high-in
ntensity elecctric stimulation training
progra
am for stren
ngth, aquaticc therapy) are not include
ed in the
progra
am because
e the expert panel believves that it is unreasonab
ble to
expecct all sites to
o carry out su
uch treatmen
nts.
Progrression from one phase to the next is based on the patient
demo
onstrating rea
adiness by achieving
a
functional criiteria ratherr
than the time ela
apsed since
e surgery. The
T timefram
mes identifie
ed in
paren
ntheses afterr each Phase are approxximate timess for the ave
erage
patien
nt, NOT guid
delines for progression. Some patie
ents will be re
eady
to pro
ogress soone
er than the timeframe identified, whe
ereas otherss will
take longer.
r
ed number of
o visits to the
e rehabilitatiion specialisst
The recommende
(including visits merely
m
for evvaluation and
d/or exercise
e progression) is
g early
16 to 24 visits witth the majority of the visits occurring
eekly x 6 we
eeks). Howe
ever, it is reccognized tha
at some patiients
(Biwe
health
h plans are severely
s
restrictive. Forr this reason, the minimu
um
numb
ber of post-A
ACL reconstrruction visits to a rehabilitation speciialist
has been
b
set at 6 visits for th
he MOON grroup patientss.
Sports Medicin
ne
UNIVERSITY OF CO
OLORADO
ACL Reha
abilitation Guidelines
G
s
Norm
mal gait
ARO
OM 0 to 120 degrees
d
of flexion
Stren
ngth: 20 SLR
R with no lag
g
Minim
mal effusion
Patie
ent education
n on post-op
perative exerrcises and need
n
for com
mpliance
Educ
cated in amb
bulation with crutches
Educ
cated in MOO
ON follow-up
p expectatio
ons
Full knee
k
extension ROM
Good
d quadricepss control (> 20
2 no lag SL
LR)
Minim
mize pain
Minim
mize swelling
g
Norm
mal gait patte
ern
U
WBAT
T with crutches (beginnin
ng the day of surgery)
Crutch Use:
Crutch D/C
D Criteria
a:
Norm
mal gait patte
ern
Abilitty to safely ascend/desc
a
cend stairs without
w
notew
worthy pain or
o instability
(recip
procal stair climbing)
c
Knee Im
mmobilizer: None (Exception: First 24
2 hours afte
er a femoral nerve blockk)
Cryothe
erapy: Cold with
w compre
ession/elevattion (e.g. CryyoCuff, ice with
comp
pressive stoccking)
Crushed ice in th
he clinic (posst-acute stag
ge until D/C))
ACL Reha
abilitation Guidelines
G
s
EXERCISE SUGGESTIONS
ROM
Patellar mobiliza
ation (media
al/lateral mob
bilization inittially followed
d by
supe
erior/inferior direction
d
wh
hile monitorin
ng reaction to
t effusion and ROM)
Muscle Activation/S
A
Strength
Quad
driceps sets emphasizin
ng vastus late
eralis and va
astus medialis activation
n
Electtric Stimula
ation: Option
nal if unable to perform
m no lag SLR
RDiscontinue use
e when able to perform 20
2 no lag SL
LR
Standing Thera-B
Band resistted terminal knee extenssion (TKE)
Hamstring sets
Hamstring curls
Side--lying hip ad
dduction/abd
duction (Avoiid adduction
n moment in this phase with
w
conc
comitant grad
de II III MC
CL injury)
Quad
d/ham co-co
ontraction su
upine
Ankle
e pumps with Thera-Ban
nd
Cardiop
pulmonary
Scar Ma
assage (whe
en incision iss fully healed
d)
CRITERIA FOR PRO
OGRESSION TO PHAS
SE 2
20 no
o lag SLR
Norm
mal gait
Crutc
ch/Immobilizzer D/C
ROM
M: no greate
er than 5 active extensio
on lag, 110 active flexio
on
ACL Reha
abilitation Guidelines
G
s
Full ROM
R
Impro
ove muscle strength
Progress neurom
muscular retrraining
EXERCISE SUGGESTIONS
ROM
Flexibility stretch
hing all major groups
Strength
hening
Quadrice
eps:
Quad
d sets
Mini--squats/wall--squats
Step--ups
Knee
e extension
Leg press
p
Hamstrin
ngs:
Hamstring curls
Resis
stive SLR with sports co
ord
ACL Reha
abilitation Guidelines
G
s
Other Mu
usculature:
Hip adduction/ab
a
bduction: SLR or with eq
quipment
Neuromuscular training
Wobble board
Rock
ker board
Singlle-leg stance
e with or with
hout equipm
ment (e.g. insstrumented balance
b
systtem)
Slide
e board
Fitterr
Cardiop
pulmonary
Bike
Ellipttical trainer
Stairmaster
Full ROM
R
Minim
mal effusion//pain
Func
ctional streng
gth and conttrol in daily activities
a
IKDC
C Question # 10 (Global Rating of Fu
unction) sco
ore of > 7
10. How
w would you rate the function of yo
our knee on
n a scale of 0 to 10 with
h 10
being normal, excellent
e
fun
nction and 0 being the
e inability to
o perform an
ny of
yourr usual daily
y activities?
?
10
ACL Reha
abilitation Guidelines
G
s
PHASE 3: Strength
hening & Co
ontrol Phase
e
1
(Approximate time frrame: weekss 7 through 12)
GOALS
Main
ntain full ROM
M
Runn
ning without pain or swe
elling
Hopp
ping without pain, swellin
ng or giving--way
EXERCISE SUGGESTIONS
hening
Strength
Squa
ats
Leg press
p
Hamstring curl
Knee
e extension 90
9 o to 0o
Step--ups/down
Lung
ges
Shutttle
Sporrts cord
Wall squats
Hopp
ping without pain progression
(Bilatteral hop/jum
mp progressing to single
e leg ending in squat.
Hop and hold witth alignmentt AP, medial-lateral, crosss)
Neuromuscular Tra
aining
Pertu
urbation train
ning
Instru
umented tessting systems
Varie
ed surfaces
ACL Reha
abilitation Guidelines
G
s
Cardiop
pulmonary
Straig
ght line runn
ning on tread
dmill or in a protected en
nvironment
(NO cutting or piivoting)
OGRESSION TO PHAS
SE 4
CRITERIA FOR PRO
Runn
ning without pain or swe
elling
Hopp
ping without pain or swe
elling (Bilate
eral and Unila
ateral)
Neurromuscular and
a strength
h training exe
ercises witho
out difficulty
PHASE 4: Advance
ed Training Phase
(Approximate time frrame: weekss 13 to 16)
GOALS
Runn
ning patternss (Figure-8, pivot drills, etc.)
e
at 75% speed witho
out difficulty
Jump
ping without difficulty
EXERCISE SUGGESTIONS
sive Strengtthening
Aggress
Squa
ats
Lung
ges
Plyom
metrics
ACL Reha
abilitation Guidelines
G
s
Agility Drills
D
Shufffling
Hopp
ping
Cario
oca
Vertical jumps
Runn
ning patternss at 50 to 75
5% speed (e.g. Figure-8))
Neuromuscular Tra
aining
Pertu
urbation train
ning
Instru
umented tessting systems
Varie
ed surfaces
Cardiop
pulmonary
Runn
ning
Othe
er cardiopulm
monary exerccises
Maximum vertica
al jump witho
out pain or in
nstability
75% of contralate
eral on hop tests
IKDC
C Question # 10 (Global Rating of Kn
nee Function) score of > 8
10. How
w would you rate the function of yo
our knee on
n a scale of 0 to 10 with
h 10
being normal, excellent
e
fun
nction and 0 being the
e inability to
o perform an
ny of
yourr usual daily
y activities?
?
10
ACL Reha
abilitation Guidelines
G
s
PHASE 5: Return-to
o-Sport Pha
ase
(Approximate time frrame: weekss 17 to 20)
GOALS
85% contralatera
al strength
85% contralatera
al on hop tessts
EXERCISE SUGGESTIONS
sive Strengtthening
Aggress
Squa
ats
Lung
ges
Plyom
metrics
Sport Sp
pecific Activ
vities
Interv
val training programs
p
Runn
ning patternss in football
Sprin
nting
Chan
nge of directtion
Kicking in soccerr
Spikiing in volleyb
ball
Skill / biomechan
nical analysiss with coach
hes and sports medicine
e team
RETURN
N-TO-SPOR
RT EVALUAT
TION RECO
OMMENDAT
TIONS:
Vertical jump
Dece
eleration shu
uttle test
ACL Reha
abilitation Guidelines
G
s
RETURN
N-TO-SPOR
RT CRITERIA
A:
No fu
unctional com
mplaints
Conffidence when
n running, cu
utting, jumpiing at full speed
85% contralatera
al values on hop tests
IKDC
C Question # 10 (Global Rating of Kn
nee Function) of > 9
10. How
w would you rate the function of yo
our knee on
n a scale of 0 to 10 with
h 10
being normal, excellent
e
fun
nction and 0 being the
e inability to
o perform an
ny of
yourr usual daily
y activities?
?
10
10