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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