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Anterior Cruciate Ligament

Patient Management

Physical Therapy Pre-operative Rehabilitation

Initial Assessment 11/12/96

Subjective: Patient is an 18-year-old white female presenting with right knee pain, which was worse laterally than medially. Patient stated the injury occurred on 11/01/96 while playing basketball when she fell after a rebound. Patient reported hearing a “popping” sound in her right knee after landing, but did not twist her ankle. Patient stated she had “pain all over and increased swelling in her knee” through the week. Patient was scheduled for ACL reconstruction on 12/20/96.

Objective: Patient ambulates full weight bearing with crutches, demonstrating a marked antalgic gait. Right knee AROM flexion 89° and extension -4°. Strength not tested secondary to increased pain. Severe swelling noted through right knee, and special testing revealed significant instability. Sensation is within normal limits (WNL).

Assessment: Patient presents with decreased strength and ROM, as well as increased pain and edema secondary to ACL tear sustained on 11/01/96. Patient will benefit from a pre-operative physical therapy visit to establish a home exercise program (HEP) to prepare for surgery.

Problem list:

  1. Decreased ROM
  2. Decreased strength
  3. Increased edema
  4. Dependent gait
  5. Decreased neuromuscular control
  6. Increased pain

Short term goals (4 weeks):

  1. Patient will be independent in home exercise program.
  2. Patient will increase right knee AROM to within normal limits.
  3. Patient will ambulate full weight bearing with no pain.

Long term goals (24 weeks):

  1. Patient will return to sport specific activity with no pain.

Plan: Patient will be educated on pain and edema management, gait with an assistive device, as well as the goals and expectations for post-operative physical therapy. The patient will also instructed in an HEP, including heel slides, quadriceps sets, hamstring sets, straight leg raises, and ankle pumps. Patient will be seen for one visit before surgery on 12/20/96.

Progress Note 11/29/96

Right knee AROM WNL. Strength not assessed. Minimal swelling noted. Patient is ambulating full weight bearing, but holds her knee in a fixed, protective position.

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Last Update: Nov 29 2012