Biologically speaking, why is PT necessary for ACL reconstruction?

[fuzzybabybunny]

Why exactly is PT necessary, from a biological perspective?

When I read about the biological process of ligamentization of the ACL graft tissue, nothing indicates why physical exercise is necessary to make the graft stronger. My only guess is that PT makes the whole knee area stronger, which helps protect the graft while it undergoes ligamentization. But if you take it easy and do no PT for several months and let the graft ligamentize safely and undisturbed, wouldn't that accomplish the same thing?

I understand doing PT for an autograft since you have to build up strength in the area of the missing tissue that you harvested. But again, you're doing PT because of the missing tissue, not because of the graft. For an allograft you're essentially replacing a part that was torn a couple months ago.

If you don't do PT, does the graft actually end up not being as strong? Why would that be, biologically? Does not doing PT hinder vascularization or something?

If your wounded knee was at 100% before the ACL tear, the muscles and connective tissue aren't magically going to deteriorate to 20% after a couple hours of arthroscopic surgery. So why the PT?

[old goat]

1) Range of motion. Maintaining full extension and regaining full flexion
2) Strengthen the muscles. The amount of muscle and strength loss after a couple of weeks of immobilization and limited weight bearing is surprising.
Whether the pt does anything for the graft itself or not I have no idea.
This is not a medical opinion; it's the opinion of someone who has nursed his wife through 3 knee operations, 4 if you count bilateral total knees as 2 operations. Includes 1 ACL repair.

[yeahman]

The amount of muscle and strength loss after a couple of weeks of immobilization and limited weight bearing is surprising.

This was mindblowing to me--the amount of atrophy in just a few weeks takes months/years to regain.

[bourbonisgood]

Why exactly is PT necessary, from a biological perspective?

When I read about the biological process of ligamentization of the ACL graft tissue, nothing indicates why physical exercise is necessary to make the graft stronger. My only guess is that PT makes the whole knee area stronger, which helps protect the graft while it undergoes ligamentization. But if you take it easy and do no PT for several months and let the graft ligamentize safely and undisturbed, wouldn't that accomplish the same thing?

I understand doing PT for an autograft since you have to build up strength in the area of the missing tissue that you harvested. But again, you're doing PT because of the missing tissue, not because of the graft. For an allograft you're essentially replacing a part that was torn a couple months ago.

If you don't do PT, does the graft actually end up not being as strong? Why would that be, biologically? Does not doing PT hinder vascularization or something?

If your wounded knee was at 100% before the ACL tear, the muscles and connective tissue aren't magically going to deteriorate to 20% after a couple hours of arthroscopic surgery. So why the PT?

Rehab after ACLR has absolutely zero to do with the ligament (other than education regarding protection).

Pain and/or surgical inhibition of the quadriceps is profound after the procedure, and YES, muscle function does instantly go hell... and then the atrophy begins! Unless you know exactly what you’re doing, you need careful guidance to restore quad muscle CSA. You are also in PT to restore ROM, quality of gait, proprioception and otherwise just day-to-day function.

[evdog]

Pain and/or surgical inhibition of the quadriceps is profound after the procedure, and YES, muscle function does instantly go hell... and then the atrophy begins! Unless you know exactly what you’re doing, you need careful guidance to restore quad muscle CSA. You are also in PT to restore ROM, quality of gait, proprioception and otherwise just day-to-day function.

As already said, it's to regain range of motion and strength in the leg. The above is spot on.

With no PT, the swelling would eventually go down and you'd get back some range of motion. But you won't recover enough leg strength to move the leg though its full range or to do certain movements. I'm no dentist but this would probably lead to continued problems with swelling, holding up the recovery further.

In my surgery the surgeon put a tourniquet around the leg just above the knee, over the quads, and cinched it down. This basically shuts that muscle down, and with a number of days of not using it, it is difficult to get it going again. I'm at 11 days post surgery now and just now getting the quad to fire.

When I had ACL surgery the first time, I went to PT up to the point I could start biking again. Then I stopped as work got busy. I never got back full strength in that leg, and I had some pain for a long time walking down stairs, trying to crouch down, etc. I never could properly crouch down on that leg, always had to use the other one for primary support. This time around I won't make that same mistake. I'm going to keep with the PT and exercises. I may go down to one appointment a week so I can stretch them out further. And when they're all done I'll be going to a gym to keep working the legs.

You'll survive without PT, but it will make for a drawn out and miserable recovery. Curious why you would even consider not doing PT. Cost/insurance?

[splat]

It seems pt would help with vascularization.

[mcski]

PT helps w meeting hot therapists and accidentally exposing your junk during hamstring stretches

[uglymoney]

It seems pt would help with vascularization.

That is my understanding as well. The new acl needs to be put under stress but not so much that it snaps as it undegoes necrosis and then restructures itself during the first few months after the surgery. PT for the win.

To the op. Quit starting new threads. Having one acl thread per year keeps all the info in one place so that new acl club members can find the info they need in one read.

[uglymoney]

PT helps w meeting hot therapists and accidentally exposing your junk during hamstring stretches

Knee cap massage ftmfw!

Sent from my SM-G950U using Tapatalk

[yeahman]

Ha! My PT probably tipped the scales at 200 pds but she was a magician with the soft tissue work and helped me through some really painful episodes in the first couple months post op. Plus she really knew how to strategize with the KT Tape and that was another huge help. A good PT does a lot more than just direct exercises. I will feel forever indebted to her for getting me through a difficult time. She knew her shit for sure.

[old goat]

As already said, it's to regain range of motion and strength in the leg. The above is spot on.

With no PT, the swelling would eventually go down and you'd get back some range of motion. But you won't recover enough leg strength to move the leg though its full range or to do certain movements. I'm no dentist but this would probably lead to continued problems with swelling, holding up the recovery further.

In my surgery the surgeon put a tourniquet around the leg just above the knee, over the quads, and cinched it down. This basically shuts that muscle down, and with a number of days of not using it, it is difficult to get it going again. I'm at 11 days post surgery now and just now getting the quad to fire.

When I had ACL surgery the first time, I went to PT up to the point I could start biking again. Then I stopped as work got busy. I never got back full strength in that leg, and I had some pain for a long time walking down stairs, trying to crouch down, etc. I never could properly crouch down on that leg, always had to use the other one for primary support. This time around I won't make that same mistake. I'm going to keep with the PT and exercises. I may go down to one appointment a week so I can stretch them out further. And when they're all done I'll be going to a gym to keep working the legs.

You'll survive without PT, but it will make for a drawn out and miserable recovery. Curious why you would even consider not doing PT. Cost/insurance?

tourniquet for an hour or two won't harm the muscles. The immobilization is what does it.

[GoldMember]

1) Range of motion. Maintaining full extension and regaining full flexion
2) Strengthen the muscles. The amount of muscle and strength loss after a couple of weeks of immobilization and limited weight bearing is surprising.

It seems pt would help with vascularization.

This and this. I haven't had ACL but my wife has had two, both with the same surgeon who is a friend of mine. These were the reasons he cited and he was also very clear in that the rest of her recovery was up to her and the PT. He was also very explicit in preaching that she do EXACTLY as the PT instructed; no more, no less. Lastly, he was very explicit as to who the PT would be. She was the only one he really trusted his patients to as she had the best results of any in the area. I think he was probably right in that my wife skis without braces, has absolutely no problems after 21 years since the first.

[evdog]

tourniquet for an hour or two won't harm the muscles. The immobilization is what does it.

Dunno. I only had it immobilized until I got home from surgery. Then it was right onto the sofa at home using a CPM (continuous passive motion) device that moved the leg constantly - used this 4-6 hours a day the first week until I started with PT. It took over a week for the quad to start to fire, and at 2 weeks now it is still not firing real strong. Maybe its because the CPM did all the work and not active muscles. The PT seemed to think a big part of it was the tourniquet.

[stuckathuntermtn]

How is this even a question?

[old goat]

This and this. I haven't had ACL but my wife has had two, both with the same surgeon who is a friend of mine. These were the reasons he cited and he was also very clear in that the rest of her recovery was up to her and the PT. He was also very explicit in preaching that she do EXACTLY as the PT instructed; no more, no less. Lastly, he was very explicit as to who the PT would be. She was the only one he really trusted his patients to as she had the best results of any in the area. I think he was probably right in that my wife skis without braces, has absolutely no problems after 21 years since the first.

When my wife had her knees replaced the therapist had to keep telling her NOT to do stuff liking walking around the house. Just do the exercises she prescribed. She wanted to limit use of the knee to allow the swelling to go down, since getting ROM quickly is important. The strength can come later but if ROM isn't full in the first few weeks it never will be.

Dunno. I only had it immobilized until I got home from surgery. Then it was right onto the sofa at home using a CPM (continuous passive motion) device that moved the leg constantly - used this 4-6 hours a day the first week until I started with PT. It took over a week for the quad to start to fire, and at 2 weeks now it is still not firing real strong. Maybe its because the CPM did all the work and not active muscles. The PT seemed to think a big part of it was the tourniquet.

I stand corrected. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258487/
Or maybe not: https://www.ncbi.nlm.nih.gov/pubmed/11447547
In any case if there is initial muscle weakness due to the tourniquet it's temporary. And both tourniquet and non-tourniquet patients had significant weakness and atrophy (loss of muscle bulk). The main reason is lack of ACTIVE mobilization, as you figured out.