Knee stiffness is common after Anterior Cruciate Ligament (ACL) surgery. This challenge impacts rehabilitation and daily activities. This article provides strategies to reduce knee stiffness and support recovery.
Understanding Post-Operative Knee Stiffness
Knee stiffness after ACL surgery stems from physiological responses to the procedure and healing. Immediately post-surgery, the body initiates an inflammatory response, causing swelling around the knee joint. This inflammation contributes to discomfort and limits free movement.
Scar tissue formation is another factor. Excessive or disorganized scar tissue, known as arthrofibrosis, restricts joint mobility, causing pain and blocking full knee extension or flexion. Early immobilization also contributes to stiffness by promoting tissue changes and reducing range of motion.
Immediate Post-Surgery Strategies
Addressing stiffness begins immediately post-surgery with controlled interventions. Managing pain and swelling is fundamental, as excessive inflammation hinders mobility. The RICE protocol (rest, ice, compression, elevation) reduces swelling and discomfort. Elevating the leg promotes fluid drainage.
Early, gentle movements are crucial to prevent severe stiffness. Controlled exercises like heel slides and ankle pumps maintain circulation and restore range of motion. Quadriceps sets, tightening the thigh muscle, activate knee muscles without excessive movement, laying a foundation for strengthening. These actions minimize scar tissue and encourage proper joint mechanics.
Progressive Rehabilitation Exercises
As recovery progresses, a structured exercise program reduces knee stiffness and improves function. Range of motion (ROM) exercises are central to regaining flexibility.
Wall slides increase knee flexion. Prone hangs use gravity for full knee extension. A stationary bike with no resistance progressively improves knee flexion and extension.
Stretching exercises target specific muscle groups around the knee. Static stretches for hamstrings, quadriceps, and calves improve muscle length and flexibility, supporting joint mobility. Dynamic stretches, involving movement through a range of motion, prepare muscles for activity.
Strengthening exercises are important, as improved muscle control supports flexibility. Leg presses with light resistance build quadriceps and hamstring strength. Squats, initially bodyweight, enhance lower body strength and stability. Step-ups gradually build functional strength and coordination. Consistency with proper form, often under physical therapist guidance, is essential for gradual improvement.
Addressing Persistent Stiffness
If knee stiffness persists despite consistent rehabilitation, medical evaluation is necessary. Persistent stiffness, especially with pain or a mechanical block, may indicate complex issues like significant arthrofibrosis or a cyclops lesion. A doctor or physical therapist can assess and recommend specialized interventions.
More intensive physical therapy, such as manual therapy (hands-on joint and soft tissue mobilization), may be employed. Diagnostic imaging like an MRI can assess scar tissue or rule out other problems. Injections, such as corticosteroids, may be considered to reduce inflammation.
For severe, unresolving stiffness, surgical options are a last resort. These include manipulation under anesthesia (MUA) to break up scar tissue or arthroscopic lysis of adhesions (LOA), where scar tissue is surgically removed.