12 Keys to Post-Operative ACL-Reconstruction Physical Therapy

By dpope2020

January 31, 2025

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12 Keys to Post-Operative ACL-Reconstruction Physical Therapy

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In today's video we go over: 12 Keys to Post-Operative ACL-Reconstruction Physical Therapy - FPF Show Episode 160

  • 0:00 Introduction
  • 2:34 Key #1 - Why having a successful pre-operative phase is imperative
  • 7:19 Key #2 - How to reduce post-operative pain and swelling
  • 12:15 Key #3 - How to restore full knee ROM
  • 20:48 Key #4 - Individualize based on the individual (graft type, concomitant pathology, sport, individual deficits)
  • 28:37 Key #5 - Improving volitional quad control (exercise, NMES, BFR etc.)
  • 33:50 Key #6 - Progressive loading for the quadriceps
  • 38:22 Key #7 - Building a comprehensive program (strength, neurocog, perturbations)
  • 44:44 Key #8 - Progress via timelines & criteria based (LSI, torque, etc)
  • 52:37 Key #9 - Psychological readiness - critical for RTS
  • 1:02:07 Key #10 - Return to sport testing battery and timelines
  • 1:15:32 Key #11 - Collaborate with others for RTS decision making (patient, family, surgeon, psychologist, coaches)
  • 1:17:49 Key #12 - The MOST important key (You'll have to watch 😉
  • 1:19:58 ACL Tear Surgery FACE-OFF [Which is BEST for Patients?

I Think I'm Ready for Action...

- Dan Pope DPT,OCS,CSCS

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Thank you!

Dan Pope DPT, OCS, CSCS

References: 

  1. Brinlee AW, Dickenson SB, Hunter-Giordano A, Snyder-Mackler L. ACL Reconstruction Rehabilitation: Clinical Data, Biologic Healing, and Criterion-Based Milestones to Inform a Return-to-Sport Guideline. Sports Health. 2022 Sep-Oct;14(5):770-779. doi: 10.1177/19417381211056873. Epub 2021 Dec 13. PMID: 34903114; PMCID: PMC9460090.

  2. Wilk KE, Arrigo CA. Rehabilitation Principles of the Anterior Cruciate Ligament Reconstructed Knee: Twelve Steps for Successful Progression and Return to Play. Clin Sports Med. 2017 Jan;36(1):189-232. doi: 10.1016/j.csm.2016.08.012. PMID: 27871658.

  3.  Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, Thaunat M, Blakeney WG. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. 2019 Mar;53(5):289-298. doi: 10.1136/bjsports-2017-098401. Epub 2018 Sep 7. Erratum in: Br J Sports Med. 2019 Dec;53(23):e8. doi: 10.1136/bjsports-2017-098401corr1. PMID: 30194224; PMCID: PMC6579490.

  4. Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016 Jul;50(13):804-8. doi: 10.1136/bjsports-2016-096031. Epub 2016 May 9. PMID: 27162233; PMCID: PMC4912389.

  5. Hartigan E, Axe MJ, Snyder-Mackler L. Perturbation training prior to ACL reconstruction improves gait asymmetries in non-copers. J Orthop Res. 2009 Jun;27(6):724-9. doi: 10.1002/jor.20754. PMID: 19023893; PMCID: PMC3597104.

  6. Piskin D, Benjaminse A, Dimitrakis P, Gokeler A. Neurocognitive and Neurophysiological Functions Related to ACL Injury: A Framework for Neurocognitive Approaches in Rehabilitation and Return-to-Sports Tests. Sports Health. 2022 Jul-Aug;14(4):549-555. doi: 10.1177/19417381211029265. Epub 2021 Jul 8. PMID: 34236003; PMCID: PMC9214902.

  7. Capin JJ, Snyder-Mackler L, Risberg MA, Grindem H. Keep calm and carry on testing: a substantive reanalysis and critique of 'what is the evidence for and validity of return-to-sport testing after anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis'. Br J Sports Med. 2019 Dec;53(23):1444-1446. doi: 10.1136/bjsports-2019-100906. Epub 2019 Jul 9. PMID: 31289039; PMCID: PMC6858490.