Questions regarding a gentleman that tore his ACL 2-3 weeks ago.
Pre-surgical: 90 degrees flexion, lacking terminal extension
Scheduled for patella tendon graft
What can he do pre-surgury on his knee (Exercises, loading, volume)?
Well, as long as his knee ROM is what it is, he shouldn’t be doing much. The focus of his efforts @ the compromised knee should be to restore extension primarily and get the swelling down. I would make a mild recommendation of Russian E-Stim and potentially WBV in conjunction with the knee extension training as they would be useful adjuncts.
I would expect IASTM to restore extension.
When/if the knee restores extension, he should be training 100% as usual within pain-free range of motion with a focus on the vertical tibia and the following restrictions.
No double flight phase – @ no point should both feet be off the ground; lunging, pivoting, leaping are permissible within tolerance with the surgical knee in the open chain; no running, jumping, hopping, no deceleration training; acceleration has very poor risk/reward in my opinion, but if linear, it should not be provocative
No closed chain of surgical side knee, hip, or t-spine rotation; we do not want any transverse motion to trickle to the knee. This is a normal translation, but not for a compromised knee;
No open-chain knee extension beyond active ROM and quad setting.
While this appears to have a large “allowance,” use caution in terms of pain recognition and technical proficiency. There is no reason to push the envelope, but there should be plenty to do with the other leg, 2 arms, and trunk.
When can he start strength training on his knee after surgery?
This should begin before, and potentially day of if he is not groggy.
This is very arguable. I would simply suggest allowing pain to be the guide. If vertical is pain-free, and angled is painful, I’d stay vertical and keep trying to clean up the issue that is causing the pain. It is very reasonable that the local recovery of the surgical site will take several weeks depending on certain factors.