What are the postoperative guidelines for ACL reconstruction with a knee immobilizer?

Postoperative ACL Reconstruction Guidelines with Knee Immobilizer

Postoperative knee immobilizers should not be routinely used following ACL reconstruction as they provide no additional benefit and may impede rehabilitation progress. 1

Immediate Postoperative Phase (0-2 weeks)

• Immediate knee mobilization (within the first week) should be implemented following ACL reconstruction instead of immobilization with a knee brace 1
• Early weight bearing as tolerated should be encouraged within the first week post-surgery 1
• Cryotherapy is recommended in the immediate postoperative period to reduce pain and swelling 1, 2
• Compressive cryotherapy may be more effective than standard cryotherapy alone 1, 2

Early Rehabilitation Phase (2-6 weeks)

• Closed kinetic chain (CKC) exercises should be prioritized over open kinetic chain (OKC) exercises during the early rehabilitation phase 1
• Neuromuscular electrical stimulation (NMES) should be used for the initial 6-8 postoperative weeks to improve quadriceps activation and strength 1
• Isometric quadriceps weight-bearing and non-weight-bearing concentric and eccentric exercises should begin from the first postoperative week 1
• Open kinetic chain exercises (90-45°) may be introduced as early as 4 weeks post-surgery 1

Intermediate Rehabilitation Phase (6-12 weeks)

• Neuromuscular training should be incorporated in most phases of ACL postoperative rehabilitation 1
• The combination of strength and neuromuscular training should be used throughout rehabilitation 1
• Low-load blood flow restriction training may be beneficial to improve quadriceps and hamstring strength and prevent disuse atrophy in the early to intermediate phase 1
• Core stability exercises can be added to improve gait, subjective knee function, and range of motion 1

Advanced Rehabilitation Phase (12+ weeks)

• Return to running should be considered at approximately 12 weeks, using a combination of time-based, clinical, and functional criteria 1
• Plyometric and agility training can be introduced to improve subjective function and functional activities without increasing laxity or pain 1
• Aquatic therapy may be used as an adjunct to standard rehabilitation after wound healing (typically 3-4 weeks post-surgery) 1

Special Considerations

• For patients with limited access to physical therapy, home-based rehabilitation may be appropriate for highly motivated and compliant patients, but programs should be individually prescribed and monitored 1
• The duration of rehabilitation should be individualized based on the patient's ability to safely return to their preinjury activity level, with specific criteria guiding progression 1
• Driving can typically be resumed at approximately 4-6 weeks after right-sided ACLR and 2-3 weeks after left-sided ACLR 1

Common Pitfalls to Avoid

• Continuous passive motion (CPM) provides no additional benefit compared to active motion exercises and is not recommended due to cost and time constraints 1
• Kinesio-taping has minimal to no therapeutic effect on rehabilitation outcomes despite its low cost 1
• Relying solely on time-based criteria for rehabilitation progression or return to sport decisions rather than using objective functional measures 1
• Neglecting preoperative rehabilitation, which can improve postoperative quadriceps strength, knee range of motion, and potentially decrease time to return to sport 1