This FanPost was Promoted to the Front Page by Anton Tabuena
Cat Zingano's recovery from ACL reconstruction continues at a fast pace. You will recall that she injured her knee in training, and underwent ACL surgery on May 28th. In two previous posts (here and here), I detailed the mechanism of her injury, as well as the fact that she chose to have a cadaver graft for the ACL surgery. In just under one month since her surgery, she has made remarkable progress.
Cat and her husband Mauricio Zingano seem to have dedicated themselves to chronicling Cat's recovery. They periodically post updates on their website's blog, including videos and pictures of Cat participating in therapy. There is one video and a picture that are very interesting to me.
In this video, Cat is shown walking in front of a mirror. One of the first rehab goals after ACL repair (other than controlling swelling and pain) is to normalize the gait pattern. Notice that she is (a) walking in a straight line forward and backward, and (b) using the mirror. At this early stage, the knee is not ready for anything other than straight line walking. The mirror provides Cat with visual feedback to self-monitor her gait pattern. She has probably been instructed on what to watch for- inadequate knee flexion during swing, poor heel strike, etc. (If you watch closely, you can see a very subtle drop off in flexion of Cat's right knee during a few steps when compared to the left knee.) An abnormal, protective gait pattern can exist long after the surgery if it is not fixed early on. Regaining normal gait is one of the first neuromuscular "exercises" that will help to prevent inhibition of the powerful quadriceps muscles. With backward walking, the muscles of the legs are working in a similar fashion as with forward walking, except that their function is simply time-reversed. The overall goal is to rebuild the neuromuscular connection between the brain and the leg, in preparation for more advanced activity in the near future.
In the picture above, you see Cat performing a squat. The stool is set so that she will make contact with it when her knees are at about 60 degrees of flexion (by my estimation). Performing a squat is a closed-chain exercise, meaning that the foot is planted, or fixed, on the ground. Evidence-based literature on ACL rehab indicates that it is usually safe to perform closed chain exercises within the first couple of weeks post-op, within a knee range of motion of about 0-60 degrees. If she would have had the more common patella tendon graft, this exercise may have been more painful for her. The patella tendon graft takes a piece of the patella (or knee cap) bone along with the tendon. This can be a source of knee pain that could be worsened by performing a squat so soon after the surgery. Reduced post operative anterior knee pain is one of the presumed benefits of having a cadaver graft instead of the patella tendon graft.
Once again, it's worth mentioning the potential of advancing too fast after cadaver ACL reconstruction. I feel that the reduced pain from this type of surgery may be a powerful temptation for an elite athlete to push too hard, too fast and run the risk of endangering the reconstructed knee. Let's hope that Cat is patient, and is listening closely to her physician and rehabilitation team.
Jansen K, De Groote F et al. Similar muscles contribute to horizontal and vertical acceleration of center of mass in forward and backward walking: implications for neural control. J Neurophysiol. 2012;107(12):3385-3396.
van Grinsven S, van Cingel REH et al. Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18:1128-1144.