All Questions ACL Reconstruction Rehab With Mick Hughes

Check out this Q&A with world renown physio Mick Hughes talking all things ACL reconstruction rehab. In this article you’ll find a video with almost an hour of content answering common questions regarding ACL reconstruction rehab, reviewing the evidence surrounding ACLr, and debunking myths and misconceptions.



Video Highlights

Below are some featured questions we addressed during the Q&A with a nice summary for those looking for quick takeaways.


Is there benefit to performing pre-op ACLr physio AKA prehab?

YES! There is a significant amount of evidence published, with more emerging, that supports ACLr prehab to IMPROVE the outcomes of ACL reconstruction rehab. ACLr prehab has been shown to improve quality of life after ACLr surgery, a better chance to return to prior level of function, and return to sport participation. ACLr prehab should be the standard of care for people getting ACLr surgery moving forward!


Whats a coper?

Someone who can cope without an intact ACL. Mick and I chat briefly about the amount of copers out there and if they necessarily should opt for surgery. We have both seen great success with copers performing ACL reconstruction rehab without actually getting ACL reconstruction surgery, but proceed with caution.


Graft types: do they matter?

Yes, but it depends. For your first ACL reconstruction surgery – if you’re a good candidate for it – it is in your best interest to take a graft from your own body – termed autograft. Allografts, meaning synthetic or from a cadaver, tend to fail more than autografts. When comparing if you should take part of your patellar tendon vs. quad tendon vs. hamstring tendon – there are a few factors that you must consider. This includes the surgeon you’re working with and what they like to use, injury history, and your specific life/sport demands after surgery. Comparing autograft donor sites and failure rates, they tend to be the same.


Quad tendon donor site?!?

YES! Mick and I have both seen quad tendon ACLr and are seeing great results thus far!


What do you want to see ASAP after surgery during ACL reconstruction rehab

Full knee extension, minimal knee swelling, solid quad activation, and minimal quad lag.


US vs. Australia PT ACL reconstruction rehab frequency

Mick and I chat about the differences between physical therapy here in the US and physio in Australia for those going through ACL reconstruction rehab. It is surprising to hear the differences amongst the two of us as well as differences from one patient to the other.


Open Kinetic Chain (OKC) knee extension: when, how much, and why? Is it OK?

YES! Mick is super passionate about this and breaks it down when you can start this exercise, what range, and why. Listen in starting at minute 31.


Return to running: when and how

Mick and I touch base on all things getting back to running during ACL reconstruction rehab. We agreed we like to wait until 12 weeks due to a signifiant amount of individuals that experience an ACL tear injury also experience a bone bruise. The 12 week time frame helps to allow the bone to heal. Mick and I also talk about some of the performance requirements we like to see our ACLr patients meet prior to running that are outlined in the Melbourne ACL Rehabilitation Guide 2.0 However, not every person is going to run at 12 weeks after ACLr! It all depends, and we chat about this and some of the differences we see from patient to patient in ACL reconstruction rehab.


Return to sport: is it 9 months for everyone? Or should we move away from this number?

This is a hot topic and there is always new evidence emerging that supports waiting at least 9 months. HOWEVER, we need to push for a criterion-based protocol vs. time-based protocol. Also anyone under the age of 20 may want to wait until AT LEAST 12 months! Mick and I talk about our experiences and what we think. Listen in at 42:45


Want more ACLr Prehab/Rehab info!?

Check out this exercise playlist I put together featuring early stage ACLr prehab/rehab. Feel free to share it! This is a playlist I created on PrehabX. Click here to sign up free for ten days to create your very own playlist and share them with anyone.

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