First you had the bad luck of sustaining an anterior cruciate ligament (ACL) injury and now your ACL reconstruction surgery has been delayed due to COVID-19. Don’t despair, you can work on pre-habilitation and on protecting your knee from further injury while you wait. Here are 4 simple goals.
- Protect your knee from further injury! There are plenty of studies out there that report that delaying surgery can increase your risk for sustaining further knee injury (AM J SPORTS MED, Jul2019; 47(8): 1816-1824). Of primary concern is injury is to the menisci, two semi-circular cartilaginous structures that serve as bumpers between the femur (thigh bone) and the tibial plateau (lower leg bone). The menisci are very important in absorbing and distributing pressure at the knee and damage to these structures can lead to an earlier onset of knee arthritis as well as additional surgical procedures (Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2018-05-01, Volume 34, Issue 5, Pages 1520-1529). It is important to note, that it not uncommon for a person sustain a meniscal injury at the time of the initial ACL tear. What is important is that you protect your meniscus from becoming injured if it is intact or prevent further injury if was damaged at the time of the initial trauma.
- If your knee is unstable in that it gives way when you are walking then you need to be in a brace! Abnormal movement at the knee will leave the other anatomical structures at high risk for injury.
- Avoid cutting, pivoting, fast deceleration or rotational movements at the knee. Take it easy, okay! Walking on a level surface, climbing stairs or riding stationary bicycle will keep the knee in an anterior-posterior orientation (front to back) and will minimize the shear/rotational forces at the knee and decrease risks for injury. Don’t continue with an activity if it causing you increasing pain.
- Obtain full range of motion at your knee, especially extension
- One of the most challenging tasks after surgery is regaining full knee extension. https://josr-online.biomedcentral.com/articles/10.1186/s13018-019-1127-8. Working on obtaining full knee extension prior to surgery may make this post-operative goal easier. Working on passive extension exercises as well as active quadriceps contraction at end range will help to improve knee ext.
- Don’t forget about bending! Working on achieving knee flexion through gentle stretches such as wall stretches and heel slides. Don’t pull too hard on your knee…the goal is to stretch it without increasing inflammation at the knee.
- Strengthen muscles around the knee to increase stability and function
- Quadricep strengthening with knee in full extension with quad set or straight leg exercises is a one of the first post-op activities that you will work on with your Physical Therapist. Working on this before surgery will help build some strength but more importantly will teach you how to properly recruit this muscle. This will be much more challenging after surgery but if you have been doing it correctly before surgery, you will be ahead of the game.
- Don’t forget about all of the other muscles around the knee. The hamstrings are a very important knee stabilizer and having strong ankle and hip muscles will also protect the knee. Your knee may be hurting but you can still safely work on hip and ankle strengthening ex. Your physical therapist can guide you on what to work on.
4. Educate yourself on your expected post-operative recovery
Knowing what to expect will help reduce your anxiety and help you to move forward with your recovery even when it is difficult. We are in the YouTube era and watching how some other people have recovered from their surgeries will help to inspire you. Remember, not everyone has the same type of injuries and recovery from a patellar-tendon graft is different from a hamstring graft or an allograft. Here are a couple of links to videos that I found helpful when recovering from my ACL reconstruction (patellar-tendon graft)
https://youtu.be/n5AG4eaTS-A Recovery of female soccer player from week 1 to back on the field
https://www.youtube.com/watch?v=uPSxIu0dIcM Comprehensive overview from a PT
https://www.youtube.com/watch?v=7k2gS_B9Z6k Overview from surgeon
Happy Pre-habbing!
Anne-Marie PT, DScPT, MS
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