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  1. Question:  What is involved in rehabilitation?
    Answer:  Regaining knee range of motion, strength and proprioception are the most important goals of any good physical therapy program.


    Range of Motion:  After injury to the knee joint and surrounding structures, swelling, inflammation, and pain lead to decrease range of motion and eventually stiffness.  In order to regain proper knee function, especially full knee extension, range of motion must be restored.

    Strength:  The muscles surrounding the knee provide dynamic stability to the knee joint.  By strengthening these muscles, particularly the hamstrings in the case of an ACL injury, some of the ACL?s job of stabilizing the knee can be assumed by the muscles.

    Proprioception:  The body's movement in space and muscular activity is monitored by specialized nerves located in ligaments, muscles, and tendons.  This allows the brain to recognize the position of the body in space and send information back to the muscles around the joint to coordinate activity and protect against injury.  These damaged nerves in the ligament must be retrained so the muscles will move the joint properly.

  2. Question:  What is an ACL brace and how does it work?
    Answer:  There are several types of knee braces which serve different functions.

    All ACL braces fall into the category of functional braces.  A functional brace provides protection against re-injury following rehabilitation and/or surgical reconstruction of an injured knee. 

    There are two basic types ACL braces: hinge-post-strap and the hinge post-shell.  Most functional braces incorporate some form of rigid frame.  Proper fit is essential and needs to be done by a trained brace specialist.  Modern braces are much better tolerated by patients due to their lighter weight, ease of application, and comfort.

    Regardless of specific brace type, functional ACL braces are designed to attempt to control forward translation of the tibia from under the femur.

  3. Question:  If a brace works why do I need surgery?
    Answer:  Although functional ACL bracing has been found to be effective under low-level loading conditions (walking, stair climbing), the effect diminishes with increased loads (strenuous athletics with cutting and pivoting).  Current medical literature does NOT support the use of functional ACL braces to protect against repeat ACL injury after reconstruction, or instability in a nonoperatively-treated knee, during strenuous physical activity.   

  4. Question:  Who does well without surgery?
    Answer:  About one third of all patients will do well without surgery.  These patients are typically:

    Ones who are willing to decrease their activity level

    Ones who avoid cutting and pivoting sports

    Older and less active individuals

    Fair to good outcomes can be expected in the above patient groups.

  5. Question:  Who needs operative treatment?
    Answer:  Younger and/or active patients who are unwilling, or unable, to modify their activities, such as eliminating cutting and pivoting sports.

    Additionally, patients with instability while performing non-strenuous activities, or activities of daily living, do not do well with nonoperative treatment.

    The majority of patients with injuries to multiple knee ligaments have better outcomes with operative treatment.

    Rehabilitation following ACL surgery takes considerable commitment from the patient to help ensure a good surgical outcome.  A specific recovery timeline will be outlined by the surgeon and physical therapist. Patient willingness to follow the protocols can be critical for success.
 

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