1. ACL RECONSTRUCTION ACL RECONSTRUCTION T. Andrew Israel, MD Luther Midelfort Orthopaedic & Sports Medicine Center

2. INCIDENCE IN FEMALES Debate as to why more ACL injuries in females Number of variables Q-angle, Jump/landing technique, menstrual cycle, notch size, level of experience, and others

3. REHABILITATION GOALS Return athlete back to competition as soon as possible but also as safely as possible Full range of motion Equal strength Pass sport cord test and functional testing that is sport specific

4. PHASE 1(0-2wks) Range of motion emphasized Weight bear as tolerated with post-op brace and crutches Cryotherapy use important Exercises include: heel slides, extension hangs, Quad sets/SLRs, 1/3 knee bends, and toe/heel raises

5. PHASE 1(0-2wks) Sport cord exercises if pt is able to use sport cord o/w use Theraband Exercises include: 1/3 knee bends, carpet drags, and gas pedals Stationary cycling in spinning mode- adjust seat height Upper body/trunk free weights-light

6. PHASE 2(2-6wks) Continue motion exercises & use of stationary cycling Sport cord exercises Begin balance exercises-unilateral balance with reaches with uninvolved leg Aquatic Therapy Functional knee brace at 4-6 weeks

7. PHASE 3(6-12wks) Lower body stretching Sport cord exercise-add single leg 1/3 knee bends & forward/backward resistive walk to march Jogging at 8 weeks Stairstepper-light resistance Outdoor biking-WITH brace on! Stay on flat ground in the saddle

8. PHASE 3(6-12wks) Walking as much as comfortable 8-10 weeks begin slide board Hip CKC exercises Balance exercises

9. PHASE 4(12-16wks) Sport cord exercises-prepare for sport cord test at 16-20 weeks post op Forward/backward jogging with sport cord Side to Side stepping(lateral agility) Free weights-add lower body exercises - Seated leg press/hip sled, ham curls, calf raises, and Ab/adduction

10. PHASE 5(16-20wks) Sport cord test Rollerblading(flat ground) Intro to jogging outside Intro to golf

11. PHASE 6(20-24wks) Athletic Skill drills(sport specific) - begin at 50% and increase as tolerated Shark Test LEFT test 6-9 months postop - Intro to sport if cleared by Physician

12. SUMMARY Rehab program is NOT going to follow the timelines listed for each athlete Every athlete is different Strength prior to surgery/injury will affect the rehab Motivation of the athlete to do rehab outside of rehab sessions also important

13. SURGERY