Rehabilitation after ACL Tear: Pre-Operative

Anterior cruciate ligament (ACL) tear can be devastating to athletes. However, with advanced surgical technique and more research based knowledge about rehabilitation, the injured athlete can return to sport relatively quickly after reconstructive surgery. Rehabilitation starts right after the injury occurs. Usually, swelling is immediate and causes pain and loss of range of motion (ROM). The athlete may not be able to walk right after injury or even bear weight. It is important to control inflammation and regain inflammation as soon as possible.

1) Reducing inflammation
Pain and swelling should be controlled with ice and/or NSAIDs. Compression wrap and elevating the limb may also help to reduce swelling. Most surgeons will not even operate until inflammation is controlled.

2) Regaining range of motion (ROM)
The athlete will lose knee ROM due to swelling and muscle guarding after the injury. Regaining lost ROM is very important especially in extension. Again, surgery may be delayed until optimal ROM is regained.

3) Regaining quadriceps strength
Swelling/effusion in the knee shuts down quad activity and the muscle gets weak after knee injury. The stronger the quad muscle is before surgery, the easier post-operative rehabilitation will be, because regaining the quad strength is one of the focus during the rehab period.

4) Gait
The injured athlete may not be able to put weight on the injured limb after surgery or walk. Being able to ambulate with or without crutches is important. If the athlete can't walk normally or without symptoms such as pain or knee giving out, crutches should be used. A knee brace may or may not be worn.

Pre-op rehab after ACL tear should focus on controlling inflammation, regaining ROM, and regaining quad strength. However, when treating an athlete, they can stay active while protecting the injured limb using upper arm stationary bike or even walking in the pool.