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Patellar Mobility Key to ACL Success

The best way to regain full function and prevent arthritis years later after an ACL repair is by getting full motion back first before strengthening. These are the results of ACL rehab reported by J. Richard Steadman, MD, the founder of the Steadman-Hawkins Research Foundation in Vail, Colorado.

Dr. Steadman advises the order of rehab should be: motion first, then mobility, strength, power, and eccentric loading. Eccentric loading occurs when a muscle is fully contracted and slowly lengthens.

Focusing on mobility first prevents scarring and adhesions between the patella tendon and the tibia (lower leg bone). Loss of patellar motion seems to lead to postoperative stiffness and later, arthritis.

Rehab should vary based on the type of ACL repair that's done. For example, rehab after ACL repair with a single-hamstring graft shouldn't be too active at first. Double-bundle grafts may be a better choice in order to avoid degenerative joint disease 10 years down the road.

Dr. Steadman wants his patients to get 80 percent of their knee motion back during the first week after ACL repair. Strength training is delayed until motion and mobility have been restored. So for example, biking and walking are okay but heavy resistance or weight training are not allowed.

This new approach to ACL rehab may help avoid scarring and stiffness. Maintaining mobility between the patellar tendon and the tibia reduces the compression on the joint itself and prevents degeneration.

References: Gina Brockenbrough. Focusing on Mobility in ACL Rehab May Boost Patients' Postoperative Outcomes. In Orthopedics Today. April 2006. Vol. 26. No. 4. Pp. 60-61.

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