Minimally Invasive Arthroscopic Hamstring Technique

Arthroscopic Hamstring ACL Reconstruction Suggested Physiotherapy Protocol

Pre-operative phase

Physical and mental preparationOptimum delay from time of injury to reconstructionNo residual swellingFull range of motion, especially hyperextension of the kneeAdequate quadriceps strength.

 

0-2 weeks after surgeryFull terminal extension/hyperextension equal to opposite legPassive extension

  • Resited Static Hamstrings

  • Unsupported knee hangs
  • Prone knee hangs

  • Minimize swellingCryocuff
  • Relative rest
    •  Quadriceps control

     

    • Isometric quadriceps/hamstring co-contraction

    • Static quadriceps exercises

    • Straight leg raise with no extensor lag

    Flexion to 90°

     

    • Heel slides and Wall slides

    • Flexion in sitting

    Patella mobilisations – teach patient self mobilisations

    Use of crutches 1-2 weeks FWB (fully weight bearing)Avoid proprioceptive exercises and open chain exercisesRemoval of sutures and Consultant review at 2 weeksReferral to physiotherapy as an out-patient

    2-6 weeks after surgeryWean off crutches and correction of gait emphasisedMaintain full extension/hyperextension

    • Passive extension

    • Unsupported knee hangs +/- weight on knee

    • Prone knee hangs with ankle weights

    Increase flexion to full rangeHeel slides

  • Wall slides

  • Knee flexion in sitting

  • Exercise bike, resistance free pedal backwards first then forwards

    Quadriceps exercises

     

    • Isometric quadriceps/hamstring co-contraction

    • Static quadriceps exercises

    • Straight leg raise with no extensor lag

    Active hamstring curls, prone, lying and standingPatella mobilisationsControl swelling, using Cryocuff as requiredAvoid proprioceptive and open chain exercisesConsultant review at approximately 6 weeks

    6-12 weeks after surgery

    Full active range of motion, extension/hyperextension and flexionAdequate quadriceps control with no extensor lagProgress to the proprioceptive stage of rehabilitationRocker board, AP and lateral weight transfer

  • 360 degree wobble board, double/single leg

  • Trampet, single leg stance

    Closed kinetic chain exercises (avoid open chain exercises)

    • Extension in standing with theraband

    • Terminal extension leg press

    • Exercise bike with resistance

    SwimmingStatic quadriceps exercisesStraight leg raiseQuadriceps/hamstrings co-contraction

    3-6 months after surgeryAssuming full range of motion and quadriceps control, progress to:Gym Activities

    • Exercise bike with resistance

    • Leg press, increase range of motion

    • Cross trainer

    • Jogging in water

    • Progress to light jogging on treadmill if adequate control at approx 4 months

    • No step machine

    • No force resisted extension

    Continued proprioceptive trainingWobble boards

  • Trampet

  • Hopping – straight line and lateral

  • Jumping – straight line and lateral

  • Figure of 8

  • Twisting/turning gradually decreasing angle

    Return to golf at approx 4 months post surgery6 month post surgery review.

     

    6-9 months after surgeryIncrease proprioceptive trainingChanging direction

  • Acceleration/deceleration drills

    Cutting actionsSharper angles

  • Plyometric training

  • Jogging forward, backwards and side to side outdoors

     

    Commence light sport specific training but with no contactBall skills

     

    • Football drills

    • Rugby drills

    • Sprint drills

    9 months after surgeryFinal return to full contact sports after appropriate training and preparation, but prior to this there should be:No pain or tenderness

  • No swelling after progressive activity

  • No change in joint laxity and rotational testing

  • Equal side to side functional testing

    Ø      Muscular strength

    Ø      Vertical jump height

    Ø      Single leg hop for distance

    Ø      Sports specific movement patterns

    Final review 

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