Case study: ACL and LCL rehabilitation

Background

LW, a 20-year-old footballer, sustained a traumatic injury during a football match when he was tackled and landed awkwardly on his left knee. He was taken to A&E, where an X-ray revealed an avulsion fracture of the head of the fibula. Further imaging with an MRI confirmed a more complex injury, including a complete rupture of the anterior cruciate ligament (ACL) and lateral collateral ligament (LCL), as well as ruptures of the biceps femoris tendon (part of the hamstrings) and the popliteus tendon.

Surgical and Rehabilitation Timeline

LW underwent surgery to repair his LCL one-month post-injury. Following this, he commenced his hydrotherapy rehabilitation program one month after the operation. The second operation to reconstruct his ACL using a hamstring graft took place later, and he returned to hydrotherapy four weeks post-surgery.

Aquatic Physiotherapy Approach

Phase 1: Post-LCL Repair Rehabilitation

Upon beginning aquatic physiotherapy, LW was comprehensively assessed by one of our physios. The initial focus was on:

• Gait Re-Education: Teaching proper weight distribution and improving his walking pattern.
• Weight Transfer Exercises: Aiding neuromuscular control and proprioception.
• Strength Training: Activating key muscle groups including the quadriceps, hamstrings, and glutes.
• Aquatic Running and Stretching Exercises: To maintain cardiovascular fitness while minimising joint stress.

LW made excellent progress in the hydrotherapy sessions, regaining full range of motion in his knee and significant improvements in strength. By the end of this phase, he was walking unaided without a limp.

Phase 2: Post-ACL Reconstruction Rehabilitation

Four weeks post-ACL surgery, LW was re-assessed. At this stage, he was walking on land without crutches but exhibited a noticeable limp. He demonstrated:

• Reduced active knee range of motion.
• Poor quadriceps strength and control.
• Considerable anterior knee swelling.

His rehabilitation plan was adjusted accordingly, focusing on:

• Quadriceps and Gluteal Strengthening: Essential for stabilising the knee and ensuring proper joint function.
• Active Range of Motion Exercises: Improving knee flexion and extension.
• Gait Patterning: Correcting his walking technique to eliminate his limp.

Remarkably, after just six weeks post-surgery, LW had achieved sufficient quadriceps control to initiate deep-water running. This allowed him to begin cardiovascular conditioning much earlier than land-based protocols typically permit.