Philadelphia Eagle Jeremy Maclin suffered an ACL tear during practice this past weekend. The wide receiver has led the Eagles in receptions and touchdown pass catches over the past four years. Maclin is in the final year of his rookie contract and the Eagles must fill his spot because he will be unable to play this season. Rupture of the ACL was traditionally thought to be a career ending injury but with developments in surgical procedures and rehabilitation this is no longer the case.
The ACL is the anterior cruciate ligament and is found inside the joint capsule of the knee. The ACL is one of the four major ligaments of the knee and aides in providing stability at the joint. The ACL prevents the shin bone, the tibia, from sliding forward under the femur, or thigh bone. The ACL can be torn from a contact force or, more commonly, a non-contact injury can cause the ligament to rupture. This can occur with accelerating or deceleration movements where a force moves the knee towards the center of the body. Maclin’s ACL was torn through a non-contact mechanism in which he felt his knee give out which is commonly reported with an ACL tear.
Maclin plans on undergoing surgery to repair the ligament next week. During ACL reconstruction the ligament is replaced using a graft. The graft is most commonly from the patellar tendon, which is the tendon that connects the kneecap to the tibia. The graft can also be from the hamstring tendon or from donor tissue. The patellar tendon graft will most likely be used during Maclin’s surgery due to shorter recovery time with this procedure.
Rehabilitation after ACL reconstruction
After surgery Maclin will begin a lengthy rehabilitation program in order to return to the field. In most cases, it is recommended to initiate physical therapy prior to surgery. This is done to prevent strength loss, improve motion at the joint, and decrease inflammation to allow motion to be regained faster after the surgical procedure. Postoperative rehabilitation is often broken into different phases with general time frames before progression into the next phase. Time frames are not exact due to each individual’s unique response to the procedure and exercise program. Patients are progressed on an individual basis and the estimated return to play is approximately six to eight months after surgery.
The first phase of rehabilitation begins on the day of surgery and lasts for about a week. Immediately after surgery Maclin will begin walking placing weight through his leg as tolerated using crutches. After ACL reconstruction a locked knee brace is used to keep the knee in extension and protect the graft to allow healing to occur. Crutches are used for the first two weeks as well as the brace locked into knee extension. During phase one the primary focus is to restore full knee extension to allow normal gait to occur during walking. Full knee extension is imperative in allowing proper mechanics to occur at the knee in order to prevent complications from arising. Controlling inflammation, by icing and elevating the lower extremity, is also an important component during this phase. During this week bending of the knee will also begin to restore knee flexion motion. Exercises strengthening the quadriceps as well as the hamstrings will be initiated in this phase.
Phase two takes approximately three weeks with a focus on maintaining knee extension and gradually progressing knee flexion motions. Quadriceps and hamstring strengthening exercises will be progressed by increasing resistance. Stationary biking will begin during this phase to aid in gaining knee flexion range of motion and to improve muscular endurance. Step-ups, lunges, leg press, and partial squats are all exercise that can be performed during this phase. Balance activities will also be initiated. The brace will be discontinued about four weeks after surgery and crutches will also be discontinued during this phase.
The goals of the next phase are to restore full knee flexion motion, improve strength, and increase endurance. Phase three takes place from approximately week four to week ten post op. During this phase an aquatic running program can be initiated for the patient to begin running with decreased forces placed on the joint. Balance exercises will be progressed using increasingly unsteady surfaces. Plyometric exercises will be initiated towards the end of the third phase to allow strength and power gains.
During the fourth phase of rehabilitation the focus is on normalizing strength between the musculature in both legs. This phase takes place approximately between weeks 10 and 16 after surgery. Once adequate strengthening has occurred running activities will begin at approximately week 10 post op. Exercises in this phase are progressed by increasing resistance and complexity. Sport specific agility training will begin at the end of this phase with initiation of cutting activities.
The last phase of rehabilitation focuses on the gradual return to athletic activities. Before full return to sport activities the individual must have >80-90% of strength in reconstructed limb compared to uninvolved side. There are several tests that can be completed to determine whether or not the athlete is able to begin sport specific training involving contact.
Surgery is not required for all individuals who suffer an ACL rupture. For individuals who do not play high-level sports a course of physical therapy is often sufficient to restore the stability at the knee to return to prior functional levels. If you have suffered an ACL rupture or have just undergone ACL reconstructive surgery call Total Performance Physical Therapy to set up your initial evaluation and begin your road to recovery today.
For more information on physical therapy visit www.totalperformancept.com.
