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Rehabilitation after ACL reconstruction:


The following is a generalized outline for rehabilitation following ACL

reconstruction. The protocol may be modified if additional procedures, such

as meniscus repair or microfracture, were performed.

Phase I: 1 – 14 days

Goals:

  • Protect graft and graft fixation with use of brace and specific exercises.

  • Control inflammation and swelling.

  • Early range of motion (ROM) with emphasis on full extension, patella mobilizations and flexion.

Brace: Post op brace worn locked in extension for ambulation. May unlock for ROM

exercises.


Weight bearing status: Weightbearing as tolerated with crutches and brace

locked in extension. If meniscal repair or microfracture, non weight bearing

for 4 weeks.

Exercises

ROM exercises:

Passive extension – sit in a chair and place your heel on the edge of a

stool or chair; relax thigh muscles and let the knee sag under its own weight

until maximum extension is achieved.

Heel props – place rolled up towel under the heel and allow leg to relax

Flexion – limit to 90 degrees

Passive flexion – sit on chair/edge of bed and let knee bend under gravity;

may use the other leg to support and control

flexion Heel slides – Use your good leg to pull the involved heel toward

the buttocks, flexing the knee. Hold for 5 seconds; straighten the leg by sliding the heel downward and hold for 5 seconds.


Quadriceps sets in full extension

Ankle ROM


Phase II: Weeks 3 – 6 Goals:

  • Restore normal gait with stair climbing

  • Maintain full extension, progress toward full flexion range of motion

  • Protect graft and graft fixation

  • Increase hip, quadriceps, hamstring and calf strength

  • Increase proprioception

Brace: May wean out of brace when you demonstrate good quadriceps control

Weightbearing status: Weightbearing as tolerated, wean off crutches


Exercises

Continue as above, maintaining full extension and progressing to 125 degrees

Begin closed kinetic chain exercises

Stationary bicycling,

stair master: slow, progressing to low resistance

Hamstring curls

Hip abduction, adduction, extension, side lifting,

heel raises

At 4‐ 6 weeks, wall squats


Phase III: Weeks 6 – 12

Goals:

Full active range of motion

Increase strength


Exercises

Stationary bicycling, stair master, elliptical: increases resistance

Treadmill walking

Swimming, water conditioning: flutter kick only



Balance and proprioceptive training

Closed chain quad strengthening: no knee flexion greater than 90 degrees with

leg press

Phase IV: Months 3 – 6

Goals:

  • Improve strength, endurance and proprioception Begin agility training

  • Exercises

  • May start jogging program, forward/straight running only

  • Continue and progress strengthening

  • Progress to running program at 5 months

  • Begin agility training at 5 months

  • Side steps

  • Cross overs

  • Figure 8 running o Shuttle running o One leg and two leg jumping o

  • Cutting o Acceleration / deceleration / sprints / agility ladder drills

  • Initiate sport‐specific drills as appropriate

Phase V: 6 months post‐op

Goals:

  • Maintain strength, endurance and proprioception

  • Safe return to sport Exercises

  • Gradual return to sports participation

  • Maintenance program for strength, endurance


Return to sports criteria: Full range of motion No swelling Good stability

on ligament testing Full strength compared to other leg Completed

sport‐specific functional progression Running and jumping without pain or

limp


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