ACL Reconstruction

Post Operative Rehabilitation Protocol Arthroscopic ACL Reconstruction

Below you will find our current rehabilitation guidelines for the post–operative arthroscopic ACL reconstruction patient. If you have any questions or concerns please contact us.

Procedure

  • Arthroscopic ACL Reconstruction
  • Arthroscopic Partial Medial or Lateral Meniscectomy
  • Chondroplasty
  • Graft Type: Allograft
    Autograft: Patella/ Achilles/ Hamstring

    Weeks of Physical Therapy: 4 / 6 / 8 / 12 Days/week: 1 / 2 / 3 / 4 / 5

    Evaluate and Treat (according to protocol)

    Objectives:
    Must use extension brace for first 6 weeks. It must remain locked while ambulating for the first 6 weeks.
    Full extension should be reached as soon as possible
    Full Flexion should be reached by the end of week 6.
    Full resisted extension is allowed at 6 weeks post surgery.

    ACL Reconstruction Rehabilitation Protocol

    PHASE I: Post-op Weeks 1- 4.
    GOALS:

  • Protect graft fixation
  • Minimize effect of immobilization
  • Full Knee Extension
  • Weight-bearing Status:

  • Weight-bear as tolerated with two crutches
  • Therapeutic Exercises:

  • Heel Slides
  • Supine wall slides
  • Ankle Pumps
  • Quad sets
  • Patellar mobilization
  • Non-weight bearing gastro/soleus, hamstring stretches
  • 4 way SLR with brace in full extension.
  • Quadriceps isometric at 60° and 90°
  • PHASE II: Post op weeks 4-6.
    Criteria for advancement to PHASE II:

  • Good quad sets, SLR without extension lag
  • Approximately 90° of flexion
  • Full extension
  • Goals:

  • Restore normal gait
  • Maintain full extension, progress flexion range of motion
  • Protect graft fixation
  • Therapeutic Exercises:

  • Wall slides 0-45°, progressing to mini- squats
  • Stationary bike (begin with high seat, low resistance to promote ROM)
  • Closed chain terminal extension with resistive tubing or weight machine
  • Toe raises
  • Proprioception and balance
  • Hamstring Curls
  • Treadmill
  • Continue hamstring stretches, progress to weight-bearing gastrocnemius and soleus stretches
  • PHASE III: Post op weeks 6-12 weeks
    Goals:

  • Full range of motion
  • Improve strength, endurance and proprioception of the lower extremity to prepare for functional activities.
  • Avoid overstressing the graft fixation
  • Protect the patello-femoral joint
  • Therapeutic Exercises:

  • Continue flexibility exercises as appropriate for patient
  • NordicTrac, stair master and treadmill jogging with functional brace (avoid hyperextension)
  • Resisted Knee extensions
  • Advance closed kinetic chain strengthening (one leg squats, leg press 0 –45°, step ups (start small ie.. 2 inches)
  • Progress proprioception activities
  • PHASE IV: Post Op 3-6 months.
    Criteria for advancement to Phase IV:

  • Full, pain-free ROM
  • No patello-femoral joint symptoms
  • Sufficient strength, proprioception and ROM to initiate functional activities
  • Goals:

  • Progress strength, power, proprioception to prepare for return to normal work and functional activities
  • Therapeutic Exercises:

  • Continue and progress flexibility and strengthening program
  • Initiate plyometric program as appropriate for patient’s functional goals
  • Functional progression including, but not limited to:
  • Initiate sport-specific drills as appropriate for patient
  • PHASE V: 6 months post-op.
    Criteria for advancement to Phase V:

  • Sufficient joint ROM, strength, endurance, and proprioception to safely return to work or athletics
  • Physicians clearance to resume full activity
  • Goals:

  • Safe return to athletics and regular job duties
  • Maintenance of strength, endurance, proprioception
  • Therapeutic Exercises:

  • Gradual return to sports participation
  • Maintenance program for strength, endurance
  • Bracing: Functional brace may be recommended