The initial goals of treatment immediately after injury are to reduce pain and swelling and regain range of motion and strength. Even if surgery is likely, achieving as much knee motion and strength as possible can greatly reduce complications after surgery.
Immediately after an ACL injury, the so-called R.I.C.E. treatment is recommended.
R.I.C.E. stands for:
- Rest - The individual is advised to rest the knee from weight-bearing activities allowing the swelling to settle.
- Ice - Placing a cold compress or ice pack on the knee is helpful in controlling inflammation as well as helping to reduce pain.
- Compression - Utilizing an ace wrap for compression around the knee is beneficial to control the swelling.
- Elevation - Lying down with the leg elevated higher than the level of the chest is helpful in controlling and reducing swelling.
The physician may request very gradual weight-bearing exercise immediately after the initial ACL injury. Braces used early after the injury are called rehabilitation kneebraces and are off-the-shelf designs used for conservative treatment of the ligament tear. This type of brace is also used for postoperative care of the injured ACL. The rehabilitation brace, also called a post-operative brace, is used immediately post-injury in an effort to put the joint at rest and help protect it, while still allowing appropriate but limited motion. This form of bracing is available in two particular types:
- Straight immobilizer - Made of foam with two metal rods down the side that is secured with Velcro and prevents all motion.
- Hinged brace - Allows range of motion to be set by tightening a screw control.
As the swelling in and around the joint decreases and weight-bearing progresses, mild strengthening exercises are started.
Quadriceps sets are one example of strengthening exercises at this stage. With the knee placed at approximately 10 degrees from being straight, along with a small towel roll directly behind the knee, the individual pushes downward into the towel roll for a count of six to 10 seconds. This is repeated 10 times. It should be done several times throughout the day.
Increasing the range of motion of the knee becomes a very important part of the program to avoid joint stiffness and muscle tightness. Sliding the heel of the injured leg towards the buttock until a gentle stretch is felt is also a good exercise. This stretch is held for 10 to 20 seconds and is repeated 10 times, several times a day.
Bracing for the anterior cruciate ligament comes in two forms:
- Rehabilitation Brace (described above )
- Functional Brace
Functional or sport braces are available both off-the-shelf and as custom-fit. Physicians prescribe this type of brace to treat the unstable knee in people when surgery is not recommended, as well as to protect the knee in those who have had surgery. Functional braces can be worn as the individual returns to work, training, or competition. But they may be most beneficial for individuals who have some instability and who place low to moderate stress loads upon the knee. It is important to the individual who does have instability of the knee from an ACL tear that functional knee braces will guarantee against instability in activities that require cutting, pivoting, or other quick changes in direction. A well-fitting brace will not restrict normal knee movement.