Physiotherapy — Advice Letter for ACL Rehabilitation after Reconstruction
A physiotherapist writes an advice letter to a 27-year-old woman following anterior cruciate ligament reconstruction, explaining the phase 1 home rehabilitation programme, the precautions to observe, and when to contact the clinic.
Letter type
Advice
Write to
Patient
Target length
200–220 words
The case notes
Patient: Miss Sophia Nakamura, 27 years old; recreational football player
Surgery: Right ACL reconstruction with patellar tendon graft (day 5 post-op); brace in locked extension for first 2 weeks while walking
Phase 1 goals (weeks 1–6): Reduce swelling, restore quadriceps activation, achieve full passive extension, regain 0–90 degrees flexion by week 6
Phase 1 home exercises: (1) Quad sets: tighten quadriceps for 5 seconds, 3 sets of 15 reps, 3 times daily. (2) Straight leg raises: 3 sets of 10 reps, twice daily — brace locked when doing this. (3) Heel slides: gently bend knee towards 90 degrees, 3 sets of 10 reps, twice daily. (4) Ankle pumps for circulation: 20 reps each direction, every 2 hours.
Precautions: Brace must remain locked at 0 degrees (full extension) during ambulation for 2 weeks; no full weight-bearing without crutches for first 10 days; do not force flexion past the point of resistance
Swelling management: Ice for 15–20 minutes after exercises; elevate leg above heart when resting
Warning signs: Increased warmth, redness, wound discharge, fever, or calf pain and swelling (DVT risk) — contact the clinic immediately
Next review: In-clinic physiotherapy session at week 2; brace and gait reassessment
Task: Write an advice letter to Miss Nakamura explaining her home exercise programme and the precautions she must observe in the first two weeks after surgery.
Writing task
Write an advice letter to Miss Nakamura explaining her home exercise programme and the precautions she must observe in the first two weeks after surgery.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The four exercises with sets, reps and frequency
The patient must be able to perform the programme without supervision. Exercises without a clear prescription cannot be followed correctly.
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The brace-locked-in-extension precaution during walking for 2 weeks
The graft is most vulnerable in the first 2 weeks. An unlocked brace during ambulation risks graft failure. This must be stated explicitly with the duration.
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The DVT warning: calf pain and swelling with warmth or redness — contact immediately
DVT is a real post-surgical risk. Calf symptoms in the operated limb can be confused with normal post-op discomfort.
Leave out
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The full ACL reconstruction surgical technique
One orientation sentence is enough. The patient had this explained by the surgeon.
-
Phase 2 and phase 3 goals and exercises
This is a phase 1 letter. Introducing later phases creates confusion about what to do now.
Criterion in focus · Organisation & Layout
ACL rehabilitation letters organise naturally into: (1) what the exercises are and how to do them, (2) the brace and weight-bearing rules, (3) swelling management, (4) when to seek help. When exercises and precautions are mixed together, the patient cannot tell what to do from what to avoid.
Now write the letter — and find out what is blocking your Grade B
Write a 200–220 words advice letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.