Where did I go wrong after my ACL reconstruction surgery?

25 year old Mahesh underwent an ACL reconstruction 6 months back. Things were fine after surgery, not much pain, comfortable post op. He did reasonably ok exercises as shown to him. But now it’s already 6 months, he doesn’t feel confident that he can walk fast without support, he feels something is missing. Though he doesn’t fall or he doesn’t have much pain but he feels something is not right.What’s going wrong? What went wrong? Was my surgery done correctly? These were the questions looming in his mind. He was told gradually he can resume back sports, but he feels he is nowhere near it.

So what must be the issue? Many people undergoing ACL surgery face same dilemma.

First important thing is: Position of your knee post surgery.It is imperative that the testing position of the knee should be straight at 0 degree flexion. Initially patients like to keep the knee slightly bent as this is the position of comfort and is less painful. However, this can result in mild degree of flexion attitude contracture. This results in ineffective way of walking. And this takes a very long time to correct when realised at later stage. So it is important that the patient keeps the leg straight when at rest, in early post op period.

Second is: sustained focus on improving tone and endurance of quadriceps muscles by isometric and later closed chain exercises. This helps prevent extension lag (power to achieve the end range extension) at the knee. This is crucial for normal walking and gait pattern. End range extension weakness is the reason for feeling ‘weak at knee’ in post surgery months.

Third is: Improvement in sense of proprioception and balance at knee. Many patient leave exercise after first 2 to 3 months thinking all is well. However, unless the knee regains sense of balance and the positioning, sports can be difficult activity to do. The native Anterior cruciate ligament has many proprioceptor cells. The Acl graft had none. So that sense of balance has to be developed by appropriate exercises. This is the single most important factor in deciding how early patient can perform sports activities.

Fourth is: core strengthening. Our whole body acts a a chain. Any weak link in this chain can lead to weakness in carrying out high intensity movements. So it is imperative that we strengthen the whole kinetic chain of body. Probably this weakness is the thing which has resulted in tear of ACL. So it is important to develop core muscle strength of whole body. This includes spine, abdominal muscles, glutei and calf muscles. When we pay attention to all these aspects after ACL reconstruction surgery, the results are amazing and satisfactory. A good surgery is just the beginning of the journey back to sports after an ACL injury.For more information please visit our website