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ACL Injuries Post- Surgery Physiotherapy management

ACL Injuries

With more than 200000 anterior cruciate ligament injuries in the per year, 65% of these injuries require reconstructive surgery, making it one of the most frequent injuries in various sports. According to estimates, there are between 0.06 and 10 ACL injuries every 1,000 football game hours. ACL injuries are more common in professional athletes. The majority of injuries happen when the opposing team is in possession of the ball and the players are defending; tackling and cutting are thought to be the most frequent playing behaviours linked to injuries (51% and 15%, respectively).

ACL Injuries surgery

Several variables contribute to the increased risk for females, including higher valgus stress and loading during tasks, variations in the strength ratios of the hamstrings/quadriceps and the vastus lateralis/semitendinous, lateral and posterior hip insufficiencies, and non-dominant leg muscles. A case series report by Brophy et al found no gender differences, nevertheless.

According to this study, the mechanism of injury differed between male and female athletes. Male athletes were more likely to sustain contact injuries (56%) than female athletes, who were more likely to get non-contact injuries.


Objectives for Urgent Management

The goal at this point (0–6 weeks after surgery) is to safeguard the surgical repair or reconstruction and have the patient ready to regain function. There are specific objectives for acute management that must be taken into account:


Combined Homeostasis Management of Scars

ROM in all planes

independent quadriceps exercise and final extension range

a long-term plan for a recuperation period of 6–9 months. to create a map for your patient and identify time-specific benchmarks to assist in creating your programme.


One of the most frequent side effects is loss of extension. The quadriceps' capacity to fully recover will be hampered by even a mild knee flexion contracture, which is crucial for functional outcomes. The knee must be able to maintain full extension in order for the quads to function as effectively as possible. In order to reduce the surface area of load distribution throughout the entire joint surface while standing and so prevent arthritis formation, full extension is also important.


After ACL surgery, quadriceps activation failure is frequent and frequently bilaterally reported. Arthrogenic muscle inhibition is the inability of the muscle to contract in the absence of underlying disease to the muscle or the innervating nerve. This occurs as a result of the injury and creates a medical barrier to rehabilitation.


With the use of multiple manual therapy approaches, there was a documented decrease in quadriceps inhibition. To lessen quads inhibition, cryotherapy, transcutaneous electric nerve stimulation, and neuromuscular electric stimulation were also applied.

By helping the patient learn to fire the quadriceps muscle on their own, you can minimise overlapping firing patterns and compensations from other muscles.

There are nine key phases in a multi-phased ACL rehabilitation programme, and each one demands a specific amount of time that should be tailored to the athlete's requirements:


ROM maintenance and defence

Weight Supporting Tolerance

Endurance

Strength \sPower \sRunning

Agility and Quickness

Return to Play Return to Training.

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