Injury: Anterior Cruciate Ligament (ACL)

Sean Rafferty

Major Goals of rehabilitation of ACL injured knee:

1. Gain good functional stability
2. Repair muscle strength
3. Reach the best possible functional level
4. Decrease the risk for re-injury

Understanding the ACL: The Anterior Cruciate Ligament, or ACL, attaches to the front of the
tibia and back of the femur. The main function of the ACL is to prevent the tibia from sliding
forward on the femur and to help stabilize the knee joint.

Mechanism of Injury: Most ACL injuries happen during sports and fitness activities that can
put stress on the knee joint. The forms of injury include that the foot is planted and the opposite
knee pivots while running. In addition, a strong blow to the side of the knee can cause a tear in
the ACL.

Types of ACL Tests: To test for an ACL tear, there are three types of tests that can be used. The
first test is the Drawer Sign. To perform this test the hips must be flexed at 45° and knees flexed
at 90°. This test is the easiest to perform as the therapist pulls on the tibia whilst sitting on the
knee to look for laxity or loose knee ligaments. The second test is the Lachman Test. To perform
this test, the therapist holds the patient’s leg and femur straight, while lifting the tibia. Whilst
performing this test, the therapist looks for instability in the knee. The final alternative type of
test is the Pivot Shift. This test detects instability in the knee through “joint play” or the motions
of sliding, rolling, or compressing that occur between bony surfaces within a joint when the
bones move through ranges of motion.
 Drawer Sign Test Lachman Test Pivot Shift

Test

ACL Protocols: In terms of ACL rehabilitation plans, different therapeutic companies have two
different schools of thought; conservative or aggressive. A therapist who uses a conservative
approach waits until the stitches have come out from the surgery. This typically takes about 10-
14 days or longer. On the other hand, a therapist who uses an aggressive approach to the
rehabilitation of the ACL begins working on strengthening immediately following, or prior to the
surgery.

Success Criteria: The first goal in the rehabilitation process is the quad set. For this goal, the
patient can successfully engage the quad muscle five times. A patient who can not complete this
step will have their quad muscle buckle or give-way due to inhibition from swelling and
weakness.
The second goal in the rehabilitation process is full knee extension. For this goal, the patient can
extend their knee, whilst exhibiting proper tibia alignment. The patient must also be able to bear
weight, or bony stress, properly with full knee extension.
The third goal in the rehabilitation process is assisted ambulation, or assisted walking. In this
step, the patient will learn how to walk with a crutch with the ACL injury. For example, if the
right knee is injured, the crutch should be on the left side of the patient. This ambulation motion
can be described through the Phases of Gait. In this, the patient must step forward with a heel
strike, place their foot flat on the ground, bring the other foot to mid stance, and “toe off” or
bring the foot up so only to toes or touching the ground.