Melbourne ACL Rehabilitation Guide 2.0

Authors

• Randall Cooper: Experienced Sports Physiotherapist, former Olympic and AFL physiotherapist.
• Mick Hughes: Physiotherapist & Exercise Physiologist specializing in ACL injury management.

Introduction

• A criteria-driven ACL rehabilitation protocol.
• Designed for clinicians and patients post-ACL surgery.
• Emphasizes individual pace through rehabilitation, guided by criteria rather than a strict timeline.

Key Tips for ACL Rehabilitation

• Straighten the knee early (within 2-3 weeks post-injury/surgery).
• Use knee pain/swelling as a guide.
• Focus on proper technique to avoid compensation patterns.
• Gradually build high-impact forces.
• Complete the full rehabilitation protocol.

Phases of ACL Rehabilitation

1. Pre-op Phase: Injury Recovery & Readiness for Surgery

   • Goals: Eliminate swelling, regain full range of motion, regain 90% quad and hamstring strength.
   • Activities: Icing, range of motion exercises, low impact aerobics, progressive strengthening.

2. Phase 1: Recovery from Surgery

   • Goals: Achieve knee straightness, settle swelling, get quadriceps firing.
   • Management: Ice, compression, quadriceps setting exercises, gentle range of motion exercises.

3. Phase 2: Strength and Neuromuscular Control

   • Goals: Regain single-leg balance, muscle strength, and control in single-leg squats.
   • Exercises: Bodyweight exercises, gym-based resistance, balance and coordination exercises.

4. Phase 3: Running, Agility, and Landings

   • Goals: Excellent hopping performance, agility program completion, full strength and balance.
   • Activities: Agility drills, jumping, hopping, gym-based strength and neuromuscular program.

5. Phase 4: Return to Sport

   • Criteria: Melbourne Return to Sport Score > 95, athlete confidence, ACL injury prevention program.
   • Emphasis: Progressive training, neuromuscular patterning, mental readiness.

6. Phase 5: Prevention of Re-Injury

   • Components: Plyometric, balance, and strengthening exercises.
   • Program: Must be ongoing, performed before every training session and game.

Outcome Measures and Testing

• Pre-op Phase: Passive knee extension/flexion, strength and swelling tests, single hop test.
• Phase 1: Passive knee extension/flexion, quadriceps lag test, stroke test for swelling.
• Phase 2: Prone hang test, functional alignment test, side bridge endurance test, balance tests.
• Phase 3: Single hop test, triple hop test, side hop test, dynamic balance tests.

Melbourne Return to Sport Score (MRSS2.0)

• Assessment tool with six components for evaluating readiness to return to sport.
• Includes clinical examination, subjective knee evaluation, functional testing, and general fitness.

Injury Prevention Programs

• Programs like Sportsmetrics, The 11+, PEP, and others are recommended.
• Aim to improve neuromuscular control during movements.

Bibliography

• Wide array of references covering various studies and methodologies related to ACL rehabilitation and injury prevention.