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The knee joint complex is extremely elaborate and includes three articulating surfaces,
which form two distinct joints contained within a single joint capsule: the patellofemoral
and tibiofemoral joint. The static stability of the knee joint complex depends on four
major knee ligaments, which provide a primary restraint to abnormal knee motion. These
are the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), Medial
(tibial) collateral ligament (MCL) and lateral (fibular) collateral ligament (LCL).
The ACL is a unique structure and is one of the most important ligaments to knee
stability, serving as a primary restraint to anterior translation of the tibia relative to the
femur, and a secondary restraint to both internal and external rotation in the non– weight-
bearing knee. The ACL originates on the inner aspect of the lateral femoral condyle in the
intercondylar notch and travel obliquely and distally through the knee joint. It inserts on
the anterior intercondylar surface of the tibial plateau, where they partially blend with the
lateral meniscus.
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Anterior Cruciate Ligament Reconstruction
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should be included. Patellar mobilisations can also be included to prevent adhesions.
Isometric quadriceps exercises may be carried out to prevent muscle atrophy. This may be
combined with electrical stimulation of the muscle to prevent muscle atrophy. Other
exercises include ankle pumps, hip abduction and adduction and assisted straight leg
raising. Gait training should be done with crutches with weight bearing as tolerated.
During this phase, hydrotherapy can be initiated as wound closure should be complete by
two weeks. Buoyancy assisted exercises may be done in water to increase and maintain
range of knee extension and flexion. These exercises may be done in standing. Buoyancy
resisted exercises may be done for strengthening of the lower limb musculature.
Simultaneously, the warm environment of the pool water may allow muscles to work
effectively owing to arise in temperature and of relaxation of any muscle spasm. It may
also have a pain relieving effect. On the other hand, land based strengthening and
mobilisation exercises do not provide such relief and relaxation.
Hydrotherapy has also been found to reduce joint effusion more effectively than land-
based exercises due to effects of hydrostatic pressure. Furthermore, there is an enhanced
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delivery of manual techniques such as patellar mobilisations in water than on land.
Propriceptive exercises and balance training may be effectively carried out both on land
and in water. However, fear of water and poor balance may impede such exercises in the
pool.
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• Normalize neuromuscular control
• Return to previous activities
Further strengthening in water may be done by using other properties of water such as
turbulence and drag which increases resistance to exercise. Equipments such as hydro-
tone boots and fins can be used to generate more resistance when performing buoyancy-
resisted exercises. In addition, increasing the speed of motion through water generates
further drag. Metacentric exercises can be done in water to improve balance. Deep and
shallow water running may be done to improve endurance. Other exercises such as
swimming may be done to improve cardiovascular fitness.
The final aim of rehabilitation is sociocultural reintegration. Thus, the individual should
be able to return back to his/her previous activities. For example, an athlete should
practice his style of running in water.
Conclusion
The physical properties of water result in beneficial effects on the body such as the
reduction in pain, increases in ROM, improved coordination of movement and early
restoration of joint ROM. Thus, a hydrotherapy programme is recommended in addition
to a land based for a quicker and safe rehabilitation. However, the aim of rehabilitation
should be that the individual is fully functional on land as humans do not live in water!