Table 1 Time and criterion-based rehabilitation scheme for the first six months after ACL reconstruction [14,15,16] divided into 5 phases (first column). Objectives (middle columns) and interventions (right column) contain the therapy and diagnostics. Note that the retrospective data analysis are based on the diagnostical measures frames in black
Phase | Objectives | Physiotherapeutic and diagnostic scheme |
|---|---|---|
Prior to surgery | - Conservative preservation of skeletal muscle mass and function (immediately after the diagnosed injury) | - Alleviation of pain - swelling measures - Detonisation and lymph measures - Proprioceptive training - Quadriceps muscle strength training |
- Biomechanical diagnostics to assess muscle function and strength prior to surgery | - Isokinetic force measurement of thigh extensors and flexors - Concentric isokinetic protocol: 60°/s (extension) – 60°/s (flexion) | |
Phase 1 (week 1–2) | - Angular mobility in flexion and extension (90/0/0) - Isometric quadriceps activation - Activities of daily living | - Alleviation of pain and stiffness - Passive and active knee mobilization - Patella mobilization - Isometric quadriceps activation - Gait training (with walking sticks) - Proprioceptive training (bipedal) - Bicycle ergometer - Neuromuscular stimulation with Compex® |
Phase 2 (week 3–6) | - Reduction of pain and detonisation - Angular mobility in flexion and extension (> 110/0/0) - Progressive improvement in muscle-coordination - Normalization of gait pattern - Stair climbing | - Passive and active knee mobilization - Gait training (without walking sticks) - Proprioceptive training one-legged - Coordination in closed kinematic chain (Squat, Squat lunges) - Hip and core stability training - Bicycle ergometer - Neuromuscular stimulation with Compex® |
Phase 3 (week 7–12) | - Symmetrical knee mobility and active range of motion - Running, cycling and crawl-swimming | - Strength development (maximal strength) in open and closed kinematic chain - Increasing proprioceptive training - Running and jumping “ABC” with stable leg axis - Jogging (symptom-free running and jumping is a prerequisite) |
Phase 4 (week 13–26) | - stretch shortening cycle without pain - Jogging outdoors | - Progressive running and jumping “ABC” with stable leg axis - Continuation of maximal strength development - Explosive strength - Stretch shortening exercises including ballistic jumps i.e. hops and drop jumps, squat and countermovement jumps |
- Biomechanical diagnostics approx. 6 months after surgery diagnostics to assess muscle function and strength prior to surgery to evaluate target-orientated therapy | - Isokinetic force measurement of thigh extensors and flexors - Concentric isokinetic protocol: 60°/s (extension) – 60°/s (flexion) |