The first step of rehabilitation is to reduce fluid in the knee, improve strength, and optimize flexion and extension. But also: discussing treatment options and the pros and cons of a surgical and conservative course. The second step focuses on improving functional strength, coordination and stability. The intensity is built up according to load capacity and the exercise therapy focuses more and more on your sport. In addition to training the muscles around the knee, it is important to train the entire chain. Think of the trunk, hip and ankle. Fitness should also be built up in this phase.Progression should be evaluated in each phase. Especially in the last phase, when sports resumption is possible, it should be discussed whether resuming your sport is wise. It is an individual decision that you make in close consultation with your physical therapist or orthopedist. If necessary, you can adjust your sports level downward, or choose another sport. An anterior cruciate ligament reconstruction remains an option even then. In case of sport resumption, the intensity will have to be built up further and outdoor training should be part of this.

Conservative rehabilitation will be as intensive and sport-specific as after anterior cruciate ligament reconstruction. After all, the goal is sports resumption. It means training regularly and properly under the supervision of an experienced knee specialist. Wanting to get everything out of your rehabilitation means that there is also a risk of a recurrence injury during any of the training sessions. On the other hand, without a risk, the knee is not sufficiently tested to determine a proper return to sports.

Besides physically, you also need to recover mentally. For a good return to sport, confidence in your knee is essential. Most of the time, a gradual program that ends with outdoor field training is sufficient to regain confidence. A psychologist may be an option if anxiety continues to play a significant role. Should persistent symptoms and/or instability persist, an anterior cruciate ligament reconstruction can be considered. The advantage is that you have trained well. The muscles and knee are almost recovered which is an advantage for after surgery.

Preoperative

Rehabilitation varies from person to person and depends in part on your goals and the status of your knee preoperatively. On average, recovery takes nine to 12 months.

After surgery, you are usually allowed to go home the same day. At the hospital, you will be given a protocol for your first exercises at home. The stitches are removed after two weeks. In the first 10 days you can shower with water-sealing plasters or a plastic bag. For proper healing, the wound edges should not get too wet or soaked.

After surgery, begin stretching and bending the knee slowly. A 90-degree flexion is sufficient in the first few days. The focus is on full extension. Full extension should be achieved as soon as possible after surgery. A pillow or towel in the hollow of the knee is the biggest culprit; you can develop a stretch limitation with that. The knee is swollen and painful. The amount of swelling and pain varies from person to person. The location of the pain depends on the tendon used during surgery.

Swelling in the knee disrupts muscle control and leads to decreased stability and coordinative movement. In the process, the size of the upper leg decreases. This process cannot be stopped, but can be slowed down by beginning exercise immediately after surgery. The exercises focus on improving control of the thigh muscles and cooperation between them. Initially, the knee does not like pressure (standing and walking) but does like unloaded movement. For this reason, it is important to do a lot of bending and stretching exercises. As soon as the knee can be bent 100 degrees, cycling on an exercise bike is possible. Cycling is medicine for the knee. No pressure on the knee and still a lot of movement in a relatively short time. Cycling is allowed, after consulting your physical therapist, two to three times a day for half an hour.

Typically, you are allowed 50 percent load on your knee and walk with two crutches. The load with walking and standing may be built up based on the knee's response. Increasing swelling, stiffness and/or pain are signs that you are doing too much. Fine-tuning the load is important to build muscle strength. Increasing or persistent swelling causes muscle strength to decrease.

The use of crutches is phased out over the course of three to six weeks after surgery. Here it is important to monitor the knee's response. Phase out walking with crutches in consultation with your physical therapist. 

Most clients recover reasonably to well from anterior cruciate ligament reconstruction. The outcome will depend in part on the severity and extent of the injury. In addition, conditions must be right for training, and mental toughness and discipline are aspects that can affect the final result. It is also good to know that the majority of cruciate ligament clients are amateur athletes with school, jobs and/or children. These people have full-time lives in addition to their rehabilitation and cannot be engaged in their rehabilitation non-stop like a professional. Therefore, don't stare blindly at the pretty stories in the media. It's your knee and your personal recovery.

91 percent of clients expect to return to the same level of sport. In reality, only 65 percent return to the old level (amateur athletes). To the competitive level, only 55 percent return. Among professional athletes, 78-98 percent return to the old level. The chance of recurrence is about 25 percent for both the same knee and the other side. Children under the age of 18 have an even higher chance of recurrence. Therefore, take time for your recovery and slowly build up your workouts with sports.

Take time for your recovery and listen carefully to your physical therapist. Adhere to the directive of rehabilitation.

Common complaints during your rehabilitation may include:

• A stiff knee when bending and/or stretching.
• Persistent pain symptoms that do not respond well to physical therapy.
• Pain around the kneecap (common but treatable).
• Overloaded knee due to excessive strain in daily life.
• Overly progressive build-up of training load.
• Slip or fall with risk of recurrence.

Knee surgery is a conscious decision and with that comes rehabilitation. It is six to 12 weeks of disciplined adherence to the precepts and homework exercises to get the best effect from the surgery. After this period, the crucial phase is over and it is important to continue getting fit.

In addition, you always have to deal with the risks of the surgery, which the orthopedic surgeon will discuss with you.

In the cases below, always contact your attending physician:

• Standing on the leg no longer possible, whereas previously it was fine.
• Fever above 38.5 degrees Celsius.
• The knee becomes abnormally thick and starts to hurt more.
• The calf is thick, red, painful and warm (possible thrombosis leg).
• If you don't trust it for other reasons