ALL INDIA INSTITUTE OF MEDICAL SCIENCES, Bhubaneswar
Department of
PHYSICAL MEDICINE &REHABILITATION
ACL REHABILITATION PROTOCOL
POST INTERVENTIONS GOALS
SURGERY
TIME
FRAME
Stage I: ■ Patellar mobilizations (emphasize ■Full knee
0 to 2 Weeks superior/inferior glides) extension ROM
■ Motion Control Brace 0 to 90 degrees ■ 90-degree knee
■ Quadriceps sets/SLR all planes (emphasize flexion ROM
SLR without extension lag) ■ Good QS
■ Prone/standing hamstring curls ■ Emphasize
■ Passive extension (emphasize full extension) normal gait pattern
■ Prone hangs
■ Pillow under heel
■ Passive, active, and active-assisted ROM
knee flexion
■ Wall slides
■ Sitting slides
■ Prone towel pulls
■ Edema control—compression pump
■ Electrical stimulation for muscle re-
education if poor QS
■ PWB 50% to 75% with crutches or WBTT
without crutches if MCB locked in full
extension
■ Sleep in brace locked in extension
Stage II: ■ MCB full ROM ■ ROM 0 to 120
2 to 4 Weeks ■ Progress ROM to 120 degrees by week 4 ■ degrees
Progress SLR and prone/standing hamstring ■ FWB without
curls with weights crutches, no limp
■ Bike for ROM, begin low-resistance
program when ROM adequate
■ Stool scoots
■ FWB with crutches; discontinue crutches
when ambulating without limp
■ Begin double-leg BAPS, progress to single
leg
■ Begin double-leg press with light
weight/high repetitions
■ Wall sits at 45-degree angle with tibia
vertical, progress time
■ Lateral step-ups (4 inches) when able to
perform single-leg quarter squat
■ Hip machine and hamstring machine when
able to perform SLR with 10 lb
■ Treadmill (forward and backward) with
emphasis on normal gait
■ Knee extension 90 to 60 degrees
(submaximal) with manual resistance by
therapist
Stage II: ■ Progress to full ROM by 6 weeks ■Full AROM
4 to 6 Weeks ■ Begin Kin-Com isokinetic hamstring ■Normal gait
progression (isotonic/ isokinetic) ■Increase strength
■ Begin Kin-Com dynamometer quadriceps and endurance
work 90 to 40 degrees isotonics with antishear ■No increase in
pad effusion with 20-
■ Stairmaster (forward and backward) 30 minutes of
■ Progress closed chain exercises biking or
■ At 6 weeks, begin Kin-Com dynamometer ambulating
quadriceps work 90 to 40 degrees isokinetics
(start with higher speed and work on
endurance)
■ Aquatic exercises
Stage II: ■ Progress above-listed exercises
8 to 10 Weeks ■ Slow-form running with sport cord (forward
and backward)
■ Isokinetic quadriceps work at different
speeds (60, 90, 120 degrees per second)
■ Begin lunges
■ At 10 weeks, begin Fitter, slide board
Stage III: ■ Full range isotonics on Kin-Com ■No pain or
12 to 16 Weeks dynamometer (begin moving antishear pad increase in
down) effusion with
■ Knee extension machine with low increased
weight/high repetitions resistance through
■ Lateral sport cord drills (slow, controlled) ■ full ROM
Kin-Com dynamometer test hamstrings, 85% with
discontinue isokinetic hamstrings if 90% functional and
■ Progress isokinetic quadriceps to full strength tests
extension by 16 weeks
Stage IV: ■ Kin-Com dynamometer test for quadriceps,
16 to 18 Weeks retest hamstrings if necessary ■ Begin
plyometric program with shuttle,
minitrampoline, jump rope if quadriceps
strength 65%, no effusion, full ROM, stable
knee
■ Begin jogging program if quadriceps
strength is 65%
Stage V: ■ Agility training
5 to 6 Months ■ Sport-specific drills (e.g., carioca, 45 cutting,
figure-of-eight)
■ Retest quadriceps if necessary
Stage VI: ■ Return to sport if:
6 Months ■ Motion > 130 degrees
■ Hamstrings > 90%
■ Quadriceps > 85%
■ Sport-specific agility training
completed
■ Maintenance exercises two to three
times per week
BAPS, Biomechanical Ankle Platform System; FWB, full weight bearing; MCB,
motion control brace; PWB, partial weight bearing; QS, quadriceps setting; ROM,
range of motion; SLR, straight-leg raises; WBTT, weight bearing to tolerance.
