Exercise Precautions After ACL Reconstruction

In the past, rehabilitation after ACL reconstruction involved long periods of continuous immobilization of the knee in a position of flexion and an extended period (often 6 to 8 weeks) of restricted weight-bearing. Return to full activity often took a full year. What kind of precautions must be taken after ACL Reconstruction is discussed here which are,

Resistance Training—General Precautions

Progress exercises more gradually for reconstruction with hamstring tendon graft than bone-patellar tendon-bone graft.
Progress knee flexor strengthening exercises cautiously if a hamstring tendon graft was harvested and knee extensor strengthening if a patellar tendon graft was harvested.

Closed-Chain Training

When squatting in an upright position, be sure that the knees do not move anterior to the toes as the hips descend because this increases shear forces on the tibia and could potentially place excess stress on the autograft.
Avoid closed-chain strengthening of the quadriceps between 60° to 90° of knee flexion. because some study shows Contraction of the quadriceps in these positions and ranges causes the greatest anterior tibial translation and can create potentially excessive stress to the graft during the early stage of healing.

Open-Chain Training

During PRE to strengthen hip musculature, initially place the resistance above the knee until knee control is established.
Avoid resisted, open-chain knee extension (short-arc quadriceps training) between 45° or 30° to full extension for at least 6 weeks or as long as 12 weeks.
Avoid applying resistance to the distal tibia during quadriceps strengthening.

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