The anterior cruciate ligament is the most commonly injured ligament in the knee. It is the main stabilizer of the knee joint. The most common cause of such damage is sports activities (skiing, basketball, football).
The only effective treatment for such an injury is arthroscopic reconstruction followed by rehabilitation. It is important to understand that a complete tear of the anterior cruciate ligament can only be treated with surgery (arthroscopy).
This selection of exercises is specially designed to effectively restore the anterior cruciate ligament and strengthen the muscular system of the developing leg. Before starting these exercises, you must coordinate treatment with your doctor!
Clothes should be loose, it is advisable to remove shoes. Perform all exercises (especially the first days) smoothly and gradually. Remember the important principle: “Endure mild pain, do not allow severe pain.”
You can start doing the first 4 exercises right away. The rest only after your doctor allows axial loading.
Passive knee extension
Lying on your back, rest on your elbows. Roll up a towel and place it under the heel of the leg being worked out, the distance from the heel to the floor is 15 cm. Relax the leg muscles and allow gravity to slowly straighten the leg at the knee joint. Hold for 2 minutes. Repeat 3 times. Do this exercise several times a day.
Severity and recovery from a knee sprain
Typically, therapists diagnose damage to several ligaments at once. Then other structures of the knee, for example, the meniscus, also suffer. The internal collateral ligament and the cruciate ligament located in front are especially often injured. Based on the intensity of symptoms and the course of the rehabilitation period, several degrees of damage to the knee joint are distinguished. In this case, recovery from a sprained knee ligament also follows a different pattern.
- Mild degree. Diagnosed with minor injuries. Pain and discomfort go away on their own within 1-2 weeks. Additional therapeutic measures are not required for this clinical picture.
- Average. With such damage, it is already difficult for the ligaments to maintain integrity. Characterized by noticeable stiffness of movement and incessant aching pain when trying to bend and straighten the leg. For sprained knee joints, recovery takes longer; treatment is delayed for 1-2 months.
- Heavy. A ruptured knee ligament takes a long time to recover from. It is characterized by severe pain, up to a state of shock. Complete stiffness or, conversely, looseness of the kneecap appears.
Severe damage is often accompanied by internal bleeding due to rupture of blood vessels and nerve fibers. Also, this stage of severity may be accompanied by ruptures of muscle tendons or their complete separation from the bone.
Knee extension
Lying on your back, rest on your elbows. Slightly bend the knee of the leg you are working on. Straighten your knee without touching the floor. The distance from the floor to the heel in this position is 20-25 cm. Keep the muscles tense and the leg straight. Then slowly lower it back down.
Exercises with an expander
Attach one end of the expander to the ankle of your healthy leg, and the other end to a door or other stationary object at ankle level.
Causes and course of the disease
A torn anterior cruciate ligament usually occurs after playing sports. Often, the outward deviation of the tibia puts stress on the anterior cruciate ligament, causing it to tear more easily. The following situations are typical for this injury:
- violent side collision with an opponent during a game of football
- hyperextension of the knee joint
- sudden braking at full speed
- sudden change of direction at full speed
- unsuccessful landing after a jump or spin
A typical accident circumstance involves hitting an opponent's knee while playing soccer. In addition, rupture of the cruciate ligament occurs when skiing, after a fall, followed by dislocation and hyperextension of the lower leg.
As a rule, the patient feels the rupture already during the fall. The injury is often accompanied by the characteristic clicking sound of a stretched and damaged cruciate ligament. Rupture occurs only under significant force. The cruciate ligament typically supports 2400 kg. loads. However, its strength may vary: in women, the diameter of the cruciate ligament is much smaller. Therefore, they suffer from this disease much more often. In children, a more common Segond fracture is an avulsion fracture of the tibial condyle.
A posterior cruciate ligament rupture requires more force than an anterior cruciate ligament rupture. Injuries of this magnitude are usually observed during road traffic accidents, for example, when the knee joint hits the passenger compartment of a car. Therefore, injuries to the posterior cruciate ligament are much less common, namely in only 7-10% of all cases.
Half squats with resistance
Stand facing the door. Fasten one end of the expander under the knee of the leg being worked out, and the other end to a door or other stationary object at the level of the knee joint. Raise your free leg off the floor; you can hold on to a chair or armchair for balance. Bend the knee you are working on slightly (do a half squat on one leg), then slowly straighten your leg. Repeat 15 times. You can simplify the exercise by not lifting your free leg.
Exercises on a balancing platform
Stand on the balancing platform. Optimal position: feet shoulder-width apart.
Treatment and rehabilitation after knee sprain
Therapy begins immediately after the patient’s admission to the hospital of Dr. Glazkov’s clinic. Depending on the severity of the patient’s condition, doctors choose the optimal treatment regimen. Today, rehabilitation of sprained knee joints is carried out using the following methods:
- Surgical intervention. It is used if the patient has a complete rupture of the ligaments, and the situation is further aggravated by instability of the knee joint. This is perhaps the only case when conservative treatment methods are ineffective.
- Anesthesia. To relieve pain, the patient must be prescribed an intramuscular injection of an antibiotic.
- Immobilization and cryotherapy. To minimize the load on the injured limb, the traumatologist may recommend applying a splint. Cold compresses are also widely used in traumatology.
- Puncture. It is carried out if, during a joint rupture, blood enters its cavity. This is necessary to avoid suppuration, which can cause sepsis.
The patient undergoes knee ligament restoration after surgery under the supervision of experienced specialists, so you should not be afraid of surgical intervention, because in some cases this is the only opportunity to completely restore motor activity and return to a full life and sports career.
Platform rotation
- Rotate the balancing platform clockwise until its edge is in constant contact with the floor , then counterclockwise. Repeat 30 times in each direction.
- Rotate the balancing platform clockwise until its edge touches the floor , then counterclockwise. Repeat 30 times in each direction.
Cost of knee surgery
In addition to the cost of surgery for cruciate ligament rupture, it is necessary to take into account the additional costs of diagnostics, doctor's appointments and aids (eg elbow crutches), which range from approximately 1,500 to 2,000 euros. If you plan to undergo physical therapy after surgery, we will provide you with a cost estimate and email it to you.
You can obtain information about the cost of staying at the hotel, as well as possible additional treatment, on the service provider’s website.
Ankle exercises
The ankle joint is a complex joint. Recovering from an injury will require a person to focus on four factors such as:
- range of motion
- force
- flexibility
- balance
Each of these functions is critical to a healthy ankle. Various exercises will focus on one or more of these factors.
Physical therapy is an integral part of the recovery process. The exercise helps strengthen the ankle joint and prevent recurring sprains or other problems.
A 2021 study suggests that failure to perform exercises may lead to the development of chronic ankle instability, which may require surgery.
Although a person may experience slight discomfort while performing these exercises, they should not cause pain. If a person feels pain during exercise, he should stop and rest his foot.
Open reduction with internal fixation
The method is used to treat complex fractures when manual reposition of fragments and holding them in the desired position with the help of plaster is impossible. To compare bone fragments and securely fix them, submersible elements and structures are used:
- tie bolts;
- screws;
- bolts with clamp terminals;
- Kirschner wires;
- bolts with flexible rod;
- lavsan ribbons and so on.
Open reduction ensures immediate accurate comparison of fragments and their reliable fixation. After surgery, early weight-bearing ability of the limb is often preserved, which allows it to be loaded soon after surgery. Nevertheless, many experts are confident that none of the methods of open reduction can ensure complete immobility of bone fragments. Therefore, after surgery, patients require additional plaster immobilization.
Operative comparison and fixation of fragments has other disadvantages:
- Injury to soft tissue at the surgical site.
- Risk of developing infectious complications.
- The likelihood of secondary displacement of fragments due to failure of fixators.
- High incidence of pseudarthrosis.
In some cases, closed fractures are best treated by skeletal traction or transosseous osteosynthesis. These methods exclude the intervention of a traumatologist in the natural healing process. Regeneration is accelerated because the doctor does not remove the hematoma and does not damage the muscles, blood vessels, or periosteum. And the opposition of fragments and stretching of soft tissues additionally stimulates regenerative processes.
Purpose of exercise therapy
After the actual operation, the body’s recovery process takes, on average, from 3 to 8 months.
All rehabilitation measures prescribed by the doctor after stitching or plastic surgery of the anterior and posterior cruciate ligaments depend on the specifics of the condition of each individual patient.
Procedures are prescribed as needed, but a number of restorative measures, including physical therapy, are absolutely necessary.
The entire recovery process can be divided into 4 periods:
- Passive (from 3 days to 2 weeks from the date of surgery) - during this time it is not recommended to put any weight on the sore leg, careless movements should be avoided in every possible way, and medications should be taken to improve lymph drainage and relieve swelling.
- Preliminary (from the second week to 1.5 months) is the time when you can start doing simple exercises to restore muscle activity. Massage and physical treatments are welcome.
- Active (eighth to sixteenth weeks) - increase in physical activity, tasks are set to restore the pre-operative state of the injured limb, walking without relying on special support means is assigned, from the third month you can start exercising on exercise machines under the supervision of the attending physician.
- Final (17-25 weeks) – the final phase of rehabilitation after surgery to restore the cruciate ligament; the achieved result is consolidated, the patient must return to the usual load, including independent ascents and descents of stairs, driving vehicles. Moderate weight lifting is recommended to avoid re-injury.
Exercises
Exercise to restore the joint
Lie on your back. With one leg, perform the movement as if riding a bicycle, while the other leg remains motionless. Always bend and straighten your leg completely. Repeat five times, moving forward and backward.
Leg flexor muscle stretching exercise
Lie on your back with one leg extended on the floor. Raise your other leg at a 90° angle to the floor. Supporting your leg with a towel wrapped around it, lift your leg to a vertical position; the heel looks at the ceiling. You will feel a stretch in the hollow below your knee.
Leg flexor muscle stretching exercise
Sit on the floor and stretch your legs forward. Pull your toes up and press your knees to the floor. Try to reach your fingertips with your hands. Stay in this position and repeat the exercise 10 times. You will feel a stretch in the back muscles of your legs.
Muscle stretching exercise
Sit up straight and hold a towel between your knees. Press your shins and knees firmly together and hold the tension in the muscles for about 5 seconds. Then relax your muscles for 10 seconds. Repeat 5 times.
Muscle strengthening exercise
Sit straight on a chair and hold a thick book between your feet.
Lift the book by stretching your knees. Hold this position for 5 seconds, then lower your legs. Repeat 5 times. Muscle strengthening exercise
Sit upright in a chair. Raise and extend one leg. Lift your hip slightly away from the chair. Raise your legs one at a time, pointing up the inner and then the outer edge of the foot. Do 5 repetitions for each side.
Treatment of ACL rupture.
As a rule, advantage is given to conservative treatment. Only in cases of persistent dysfunction and instability is surgical treatment indicated. It is also necessary, when transporting the patient to the clinic, to provide rest to the leg and cold to the injured area to reduce swelling and to avoid an increase in hemarthrosis. For fixation, orthoses are used as the most convenient option for limb immobilization.
Conservative technique
To relieve pain and reduce the inflammatory response, non-steroidal anti-inflammatory drugs are prescribed. If hemarthrosis is present, blood is removed from the joint using a syringe. Sometimes intra-articular glucocorticosteroids are prescribed. After reducing inflammation, a course of intra-articular injections of hyaluronic acid or platelet-rich plasma can be prescribed to speed up the regeneration of damaged structures. For a speedy recovery, exercise therapy, mechanotherapy, physiotherapy, etc. are prescribed.
Anterior cruciate ligament arthroscopy
Arthroscopy is the most modern and effective method of repair for ACL rupture.
Arthroscopy is performed in cases where there is instability of the joint or other tissues are damaged. The operation is a minimally invasive method of diagnosis and treatment, since the cavity is not opened, and surgical instruments are inserted into it through two small incisions in the skin. The arthroscope allows you to visualize all structures at multiple magnification, thanks to which the doctor can most accurately make a diagnosis and begin surgical treatment.