INTRODUCTION It was in 1991 when we completed our first rehab programme for a player following ACL reconstruction. Guidelines for that programme were based on those tested and researched at the MAYO CLINIC – perhaps the top rehabilitation experts in the USA where most of the ACL techniques have been pioneered, and at the F.A. Centre at Lilleshall, England.
Since then we have developed and changed the programme in conjunction with the latest literature and data, as well as the changes in the surgical technique and recommendations from our local surgeons. Our programme has been tried tested and modified on over 1000 patients.
OUR RESULTS to date – we have put over a 1000 players and athletes through our programme, mostly County or Elite Club Gaelic Footballers hurlers and camogie players, Irish League Soccer, National level basketball players, and League of Ireland Rugby. To date we have had only two patients requiring a revision op – difficult to predict the exact cause for one patient who was referred to us late; but two others were patienst who did not follow our protocol as per instructed or put in the time and effort required.
THE TIME FACTOR As our technique has improved we have seen the time factor drop from one year to just over 7 months (for some). Patients especially motivated athletes want back to their sport ‘yesterday’ and over the last number of years we have seen the recovery time drop – partially due to the change in surgical technique partially due to advanced accelerated rehabilitation techniques. However there are certain risks to rushing back.
WARNING:Rehab will take time from 9 months to one year for some. It is impossible to give you an exact ‘BACK BY’ date as individuals progress will vary.
One of the things I do say to patients is ‘you don’t want to be going through this again’ so lets not rush and do it right.
The other side of that is – you need to keep at it – there is nothing to be gained by taking too long to rehab or taking a year out …. your new ACL needs exercise and rehab – needs stimulated at a certain time frame if the operation is to be a success. You are not just allowing the ACL to heal – it has to be stimulated to develop the graft to become a functioning ACL.
PHASE THE McACL PROGRAMME APPROX. START / FINISH TIME
1) POST OP MOBILISATION (Day 1 to Week 1)
2) MUSCLE RE-EDUCATION (Week 1 to Week 2-3)
3) STRENGTH PROPRIOCEPTION GYM – Early (Intro) (Week 2-3 to Week 6)
Full Programme (Week 6-10 to ongoing)
4) PITCH PROPRIOCEPTIVE DRILLS (Week 12-16 to ongoing)
5) PROTECTED TURNS & TACKLES (approx Week 16-18 depending on progress at Phase 3-4)
6) FULL TURNS & TACKLES (& FINAL PLYOMETRIC PHASE) (Month 5+)
7) RESTRICTED SQUAD TRAINING Once satisfactory completion
8) RETURN FULL SQUAD TRAINING of Phase 6 and completed
9) CHAMPIONSHIP TIMING McACL testing
10) FINAL CHAMPIONSHIP SELECTION
AVERAGE 10 PHASE COMPLETION TIME IS 6 TO 14 months: depends on individual, work rate and Physio input. *N.B.* Working harder does not mean rushing through the phases – you must be checked by McACL PHYSIO before progress from each phase – you may also have small set-backs along the way – but the more you rush, not following our guidelines – the greater the risk of injury!
If on ACCELERATED PROGRAMME means you must give 10 hours rehab + per week!!
ACKNOLGEMENTS: grateful appreciation in the development of the ‘McACL’ to the following:
MR. RAYMOND MORAN M.Ch. (Orth.), FRCSI
MR. RICHARD NICHOLAS BDS, MD, FRC (Orth.), FRCSI
MR. IAN CORRY BDS, MD, FRC (Orth.), FRCSI