Post-Surgical Rehabilitation

Rehabilitation after ACL surgery is an indispensable element of treatment. Today, the concept of “Functional Rehabilitation” is accepted with the increase in knowledge about the biomechanics, kinematics, functions and tissue strength of the ACL and knee (2,9,11,61,62). In this context, the rehabilitation program must include neuromuscular training (9,62-64), coordination, balance and proprioception (2,11,64-67), open and closed chain exercises (11,62) and flexibility exercises (14), performance and sports. should include exercises aimed at (9,63,65,67).

Purpose in acute period (0-4 weeks) rehabilitation after ACL surgery
* Prevention of pain and inflammation
* Gaining full extension and at least 100 degrees of flexion range of motion
* Prevention of quadriceps reflex inhibition
* Ensuring patellar mobility
Purpose of rehabilitation in the subacute period (4-8 weeks) after ACL surgery
* Ensuring normal arthrokinematics of the knee.
* Developing proprioception and balance
* Hip circumference muscle strengthening
* Ensuring smooth ambulation of the patient
Purpose in rehabilitation of chronic period (8-12 weeks) after ACL surgery
* Ensuring full range of motion in extension and flexion
* Advanced balance and proprioception training
* Advanced muscle strengthening

Today, after the development of surgical techniques and fixation methods, rehabilitation protocols have begun to be created in a more aggressive and rapid manner (64). While it was previously recommended to wait 3 weeks for full weight transfer, it is now recommended to start weight transfer immediately in new studies (3,9,11,13). Efforts are being made to return an injured athlete to the field as soon as possible in order to prevent financial loss in terms of athletes and to reduce both team performance and individual performance decline. Especially the long time to return to sports after ACL surgery creates serious psychological problems in athletes. Considering the psychology of the patient, it is necessary to continue the rehabilitation without reducing the adaptation of this period. The patient’s participation in treatment, adaptation and continuity are vital for the effectiveness of the treatment (2,3,11,61). Cicotti et al. stated that the high rate of attendance to the rehabilitation program of the patients was also effective in the success they achieved from the coordinated improvement and activity modification they applied (68). In the study of Noyes et al., they attributed the rehabilitation programs that failed after rehabilitation to the participants’ non-attendance, non-compliance with the rehabilitation programs, and ignoring the recommendations (69).

According to the review by Grinsven et al., while following the accelerated protocol in rehabilitation after ACL surgery shortens the time for the individual to return to sports, no difference was found in the short and long term compared to other protocols. In this study, it is stated that open kinetic chain exercises between 40-90 degrees can be started in the early period after ACL surgery, walking can be started without crutches from 10 days after the surgery, thus preventing patello-femoral pain and inhibiting quadriceps inhibition in the early period. He also states that at the end of the 9-week period, it is possible to start running on the treadmill (64).

Wii Therapy
2.11.1. Virtual Reality
Today, as a result of the continuous development of technology, devices that adapt to all of our lives have gradually started to be integrated into treatment methods. Virtual reality is its own simulation projected on the screen through computer or man-made electronic devices of the real environment. The individual can see his own movements on the screen through this simulation, and the individual performs the desired movements by trying to comply with the commands given by the screen (17-19,22).