Anterior cruciate ligament (ACL) reconstruction is a common operation for people with an ACL injury. While an ACL reconstruction can help people get back to their normal day-to-day activities and sports, many people who have had an ACL reconstruction do not recover to a level that they are satisfied with. Therefore, it is important to test treatments that can improve outcomes.
The aim of this study (called the SUPER KNEE study) is to compare two different exercise and activity monitoring programs. You are in the strengthening program led by a physiotherapist. It is very important that you attend the physiotherapy appointments, complete the exercises and attend all study assessments.
One of the consequences of an ACL injury is an increased risk of developing knee osteoarthritis at a young age. Having an ACL reconstruction DOES NOT reduce the risk of osteoarthritis but having strong muscles and good function can.
Osteoarthritis is a joint problem where people may have pain, joint stiffness and problems with physical function such as running, walking, stairs and standing. The cartilage in the joint breaks down and there are also changes in the bone and in the muscles surrounding the joint.
In this study, we are trying to improve your function and ability to do daily, physical and sporting activities, reduce your pain and prevent osteoarthritis development.
You are one of 184 people with an ACL reconstructed knee who are included in this study. To ensure that the results of this study are accurate, it is very important that you attend the physiotherapy appointments and complete the exercises your physiotherapist gives you. It is also important that you attend all study assessments (follow-ups at 4 and 18 months) because you get feedback on how you’re doing and we can alter your treatment accordingly.
We will contact you before each assessment to arrange a convenient time for you to attend. We will reimburse you for your travel costs to La Trobe University and the MRI facility. These assessments and all your physiotherapy treatment are free for you.
What’s involved?
To get the best outcome in the first 4 months of the study you need to:
- Complete the exercises given to you at least 3 times per week.
- We encourage you to do this with the study physios (1:1 or group) twice per week.
- Once per week at home or the physio clinic gym or your local gym.
- Often it is more fun to exercise with others and we therefore encourage you to participate in the group sessions, if possible.
- In these groups you will meet others with similar knee problems, and you can support and motivate each other.
- After 4 months, continue strengthening exercises 2-3 times per week (more if you wish) at home or your local gym (we will provide a free gym membership) up until the end of the study (18 months).
It’s motivating to see your progress! It is therefore very important that you record the exercises you do every time you do them. This should be done in the accompanying logbooks to keep track of your progress.
We will also send you a short online questionnaire via e-mail to complete at home every two weeks (during the first 4 months), and then monthly (after 4 months) so we can track your physical activity, exercises and pain. The Garmin watch we have given you will also give us an idea of your physical activity so please try and wear it as much as possible.
After your ACL reconstruction, you would have noticed that your leg muscles get weaker and that you are not as agile. Most people become less physically active and it is often difficult to build the strength back up and to be as agile as you were before you injured your ACL. It is also difficult to have full confidence in your knee.
For this study, we have developed a special exercise program to help improve your muscle strength and agility and overcome the problems that you have been having with your knee after ACL reconstruction (improve pain and quality of life).
Having strong leg muscles (stronger than before you injured your ACL) and being agile when you move is also very important to allow you to return to more physically demanding activities and sport safely.
What type of exercise?
Our muscle strengthening and agility exercise program has been developed with input from international experts to help overcome the problems that you have been having with your knee after ACL reconstruction (improve pain, activity, quality of life and prevent osteoarthritis).
How often and for how long?
The exercise-therapy program contains exercises for you to perform two times per week for 16 weeks with your physiotherapist, and an additional one time per week at home or at the physiotherapy clinic gym/local gym (3 times per week in total). This is the frequency we know will help achieve your goals. You can do the exercises more often, but all sessions must be recorded in your logbook. We recommend at least 1 rest day between strengthening exercises.
At the 16-week (4-month) follow-up strength assessment and MRI, we will provide you with a free gym membership to your local gym to be able to continue to perform the exercises up to the end of the study at 18-months.
How long are exercise sessions?
1-hour sessions are optimal, but sometimes time is short. In the exercise program later in this booklet we have included 5 priority exercises with different levels of difficulty to keep them challenging and interesting, which you should do at every session. These exercises take approx. 30mins to complete. You will also find more exercises to complete a 1-hour session (optimal)
Your physiotherapist will help adjust the program to your specific needs and to progress your exercises to keep them challenging and interesting. Exercises should be performed on both legs, but with a focus on the injured leg. We know that following an injury muscle strength and other parameters are also reduced in the uninjured leg.
Cardiovascular health and fitness
Being generally physically active (e.g. walk, cycle, run, swim etc.) and achieving and maintaining a healthy weight is good for your general health, now and in the future. International health guidelines recommend at least 150 minutes of moderate physical activity per week (e.g. 30 minutes of exercise which increases your heart rate and makes you sweat five times per week). Use your Garmin device and Garmin Connect mobile app/website to track your physical activity and try and achieve at least 10,000 steps per day.
You may have already returned to playing sport, or you may not have, or you may not want to – that’s absolutely fine!
If you want to go back to playing sport, it is important that you discuss this with your physiotherapist so they can help you transition safely to your sport to reduce the risk of re-injuring your knee. There are certain tests that the physio will do with you that can help work out when you are ready to return to sport. We know that passing these tests also helps reduce the risk of another knee injury from happening. We recommend that more than 3 months of sport-specific training is completed before resuming competitive sport.
Fear of reinjury and lack of confidence in your knee is normal!
ACL injury and reconstruction challenge people in different ways. Fear of a new injury and a lack of trust and confidence in your knee is very common. Please make sure you discuss this with your physio as they will have strategies to help build your confidence.
Physiotherapy rehabilitation, progression through exercise and gradually returning to desired activities will help to build your confidence and reduce any fear of movement or reinjury. Completing the exercise program and passing the return to sports tests are very important in overcoming any fear you might have and you will also reduce your risk of future injury.
What if I have restricted movement or knee swelling?
If you have restrictions in range of movement or swelling, your physiotherapist can use different treatments to help with this.
Can I use other treatments for my knee?
As part of this study, we request that you refrain from seeking other forms of treatment for your knee during the study (e.g. other physiotherapy treatment, osteopath, chiropractor, natural therapies etc.).
It is important that you record if you see any healthcare professionals or take any medication during the study (even if unrelated to your knee). This information is important to work out the healthcare use and out-of-pocket costs for everyone in this study. Use the accompanying “healthcare use calendar” at the end of the booklet provided – please record all healthcare visits and medications on these calendars.