Pre-Op ACL Discharge Testing Checklist Discussion

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Phil:  All right. Let's go through these guidelines. These guidelines are developed so that basically we can return you to sport without having an increased risk of retearing your ACL, hurting something else. We want that to be minimized. You don't want to go through this again. You don't want to go through this surgery again. So, we'll go through these guidelines, but additionally, we're going to have you in the gym pretty quickly working out, because we actually want to take this opportunity to improve your athleticism, to improve your performance. So we'll not only see you in the clinic, we're going to give you a very detailed guideline on what you should be doing in the gym. Do you have access to a gym? Okay, perfect.

So just to kind of go through some of these guidelines, one of the things we're going to look at, the first thing we're going to look at is range of motion. And I know the athletic trainer has been working with you, working on getting that knee fully straight. That is the most important thing after surgery. Okay. So we need to focus on getting that knee straight as the other knee. And so we're going to do things like . . . we're never going to put a pillow underneath that knee, after surgery, When we're lying down, we're going to have something underneath our heel to let that come down. It will be uncomfortable. A lot of times there is a decent amount of pain after surgery. So, you do have to kind of push through that a little bit.

The other thing we want to do, a lot of times range of motion doesn't come back because there's a lot of swelling in the knee. So we want to make sure you're doing everything to help that swelling. So you had, you know, the tubigrip that you had on, you're going to be wearing that. Immediately afterwards you're going to be in a big, post-operative dressing. But, we're going to have you, you know, work on compression. The other thing that really helps a lot is elevation. So a couple of ways to elevate is, you know, we kind of think of, you know, propping our legs up on pillows and things like that. We can do that, but we want nothing under the knee. Another great way to get it is sleeping at night. Rather than propping your leg up on pillows, which is uncomfortable, hard to sleep with, what I like to do is put a few books underneath the posts of your, bottom posts of your bed. That will elevate it just 2 or 3 in which over an entire night really helps a lot. The other thing you can do is you can put pillows between your mattress and your box spring, and make that ramp like you would underneath your leg, but then that allows you to sleep in whatever position that you want, rather than just having to lie on your back with your leg up in the air. Okay, so we're going to want to manage our swelling really well.

We're going to want to get our knee straight. It's really important. We're going to also work on the bending, that flexion range of motion like you've been working on. But the bending is not nearly as important as the straightening. So we're going to really want to focus on that. So we're going to go through all these criteria here. We're going to make sure, we're going to work on your movement. And we're going to make sure that that's restored to normal. We're going to do that through a Selective Functional Movement Assessment and the Functional Movement Screen, which are just a series of movements to make sure that your body is able to do what it needs to do. And the nice thing is, if we normalize those, we make those pain free, we know that you're going to be able to perform better, and you're going to be able to not have as risk of an injury. So it will make you more durable.

A Y Balance Test, we're going to do that. There's one for your upper body and one for your lower body. Basically, you're going to balance on one leg and reach with the other leg in other directions. Have you done that ever at a physical? Okay. We'll actually probably get those numbers, so that we can compare those numbers to what you were previously to to where you are when we want you discharged. We probably actually want you to a little bit better than you were with that. So that's going to be great to have that comparison.

Then we're going to do hop testing. We're going to do where we're hopping forward and back, side to side. We're going to hop for distance. We're going to, look at really, your vertical jump, making sure that all of those powerful movements are the same there. We're going to do strength testing. We're going to do both some strength testing where it's, just kicking out against something, and then we're going to do some strength testing, kicking out against a machine that measures it for you. And we're going to then look at how well you can jump, that you can jump in good alignment, really safe knee position with that. And then we're going to look at overall how you're feeling. That's really important. How confident you are in your knee, whether you can do the activities, whether you have pain, whether you have swelling.

So that's going to be what we're going to look at. So now we're thinking in the 6 to 7 month time frame. And that's that's a good goal. You know I like that goal. I will say that the research tells us the longer we wait, the better off we are, the more likely you're going to perform well and not get hurt again. So the research says basically nine months is our optimal time frame. Okay. So the more we can prolong it, the better off we will be. So we're going to kind of look at both. We're going to look at all of these criteria plus the time frame. So as long as we we can go. So if we kind of think about it, what grade are you?

Cam:  I’m a 10th grader.

Phil:   Okay. Sophomore. Okay. So as we kind of think about it, if we're if we're about seven months from the start of the football season . . . now, if this were your senior year, I could probably push that timeline and go, okay, we're going to really we're going to dive and we're going to try to get that. It's your sophomore year, so you're probably biggest goal is to play as a senior. Right? So while at that six month time frame, seven month time frame, we're going to have you returning to about practices, to doing drills and things like that. And what we're going to do is gradually return you and get you into full competition again, ideally probably in that nine month time frame. But that doesn't mean you're not practicing, that you're not doing stuff with the team, that you're not getting better. We're probably going to try to make that into that nine months. Or it might be even a little bit longer, depending on how well the knee’s responding. I know you're a super hard worker. If you're done, if your knee looks this good already pre-surgery, I think you've done a really good job. Do you have any questions on that?

Cam:  No.

Phil:  Awesome. Good deal. Well, let's get to it.

Get your copy of the ACL Reconstruction Guidelines here.