Proprioception: The special function of the ACL
As well as providing a restraint to abnormal knee movement, the ACL gives important information to the muscles involved in the reflex control of knee movements. Nerve fibres give the knee a sense of position and movement and this sensory awareness is known as proprioception. It is a normal feature of all joints and helps to give us balance control and confidence in movements.
After reconstruction this key function needs to be relearnt. This involves special rehabilitation exercises for the hamstrings and quadriceps (thigh) muscles along with the core strength from the pelvis and balance control work. It is more than just strength work - it is about the fine control movements in landing and pivoting in order to prevent re-injury.
Overall Rehabilitation Plan
The overall rehabilitation plan emphasises the importance of pre-operative exercises, followed post operatively by early control of swelling and regaining full extension (straightening) and flexion (bending) of the knee. Working on strength can only start once swelling has been controlled and range of movement is nearly normal. Return to function then follows.
The outline that follows is only meant as a guide and there is considerable variation in the specific goals and exercises. It is important to follow the advice of the specific responsible surgeon and rehabilitation team.
Key to Success: Working with your physiotherapist
The key to successful rehabilitation is to regain normal, full straightening of the knee as soon as possible, as well as to control swelling in the early post-operative phase before progressing to strength activities.
For the first six weeks, until the new graft is well bedded in and healed in place, exercises are performed gently with the aim of regaining normal bending and straightening as the swelling settles.
Repetitive cycling of the knee is usually restricted during the first 6 weeks as this may overload the fixation of the ligament and lead to slippage of the graft and effective lengthening of the new ligament.
During exercises the foot is initially kept in contact with the ground or with the surface of an exercise machine – these are called ‘closed’ kinetic chain exercises.
Elevation of the leg between exercises to reduce swelling is also important and helps allow the bending to improve.
‘Open’ kinetic chain exercises, where the foot is unsupported, are introduced towards the end of the first six weeks as knee control and strength improves. This allows muscle strength to improve without putting excessive stress on the graft.
The NLR has been successfully gathering patient data since 2013, after it was launched at BASK.
There are currently:
Number of active users: 712
Number of Pathways: 12098
Total Number of Registered Patients: 11796
(includes patients awaiting surgery)