Home Exercises for Post-Op Day 6 After ACL Reconstruction with Peroneus Longus Graft
At post-operative day 6, you should perform isometric quadriceps contractions and straight leg raises multiple times daily (3-5 sessions), along with ankle pumps and gentle range of motion exercises, as these can be safely started during the first 2 postoperative weeks and improve knee range of motion recovery without compromising stability. 1
Specific Exercises to Perform Now (Days 0-14)
Quadriceps Activation
- Static quadriceps contractions (quad sets): Contract your thigh muscle and hold for 5-10 seconds, repeat 10-15 times per session
- Straight leg raises: Lying flat, keep knee straight and lift leg to 45 degrees, hold 2-3 seconds, lower slowly. Perform 10-15 repetitions
- These exercises confer advantages for faster recovery of knee range of motion at 1 month without compromising stability 1
Range of Motion
- Heel slides: Gently bend and straighten your knee while lying down, working toward 90 degrees of flexion
- Ankle pumps: Move ankle up and down 20-30 times per hour while awake to prevent blood clots and reduce swelling
- Early mobilization improves knee flexion and extension range of motion without compromising knee laxity 1
Weight-Bearing
- Immediate weight-bearing as tolerated with crutches (unless your surgeon specified otherwise)
- Early weight-bearing demonstrates large effects on reducing patellofemoral pain (from 35% to 8%) with no negative effect on laxity or function 1
Frequency and Timing
Perform exercises 3-5 times daily, spacing sessions throughout the day:
- Morning session upon waking
- Midday session
- Afternoon session
- Evening session before bed
- Optional 5th session if tolerated
Each session should take 10-15 minutes. Ankle pumps should be performed more frequently (every 1-2 hours while awake).
Critical Considerations for Peroneus Longus Graft
Important caveat: Recent evidence shows that peroneus longus grafts result in significant donor-site morbidity at the ankle, including impaired ankle plantar flexion and eversion strength, along with balance deficits at 12 months 2. This means you need to pay special attention to:
- Ankle exercises: Add gentle ankle circles and towel scrunches starting now to minimize donor site weakness
- Monitor ankle symptoms: Watch for increased ankle pain, instability, or difficulty with toe-off during walking
- Balance awareness: You may experience more balance difficulties compared to hamstring grafts, so use assistive devices as needed
What to Avoid Until Week 3-4
- No open kinetic chain exercises (seated knee extension machines) until at least week 4, as there is no evidence supporting their safety before this timepoint 1
- No leg press until week 3 1
- No resisted hamstring exercises until cleared by your therapist
- Avoid excessive knee flexion beyond 90 degrees if it causes significant pain
Pain and Swelling Management
- Ice for 15-20 minutes after each exercise session
- Elevate leg above heart level when resting
- If pain increases significantly during exercises, reduce repetitions but maintain frequency
Before Your Tuesday Rehab Session
Continue this program daily until your next therapy appointment. Your therapist will likely progress you to more advanced exercises including closed kinetic chain exercises (mini squats, wall sits) and potentially begin leg press work if you're at week 3 or beyond by that appointment 1.
The key principle at this stage is frequent, low-intensity muscle activation rather than strength building - you're focusing on neuromuscular re-education and preventing quadriceps shutdown, which is the primary concern in the first 2 weeks post-operatively 1.