ACLReconstructionPostOperativeRehabilitationProtocol
ThefollowingisageneralizedoutlineforrehabilitationfollowingACLreconstruction.Theprotocolmaybemodifiedif
additionalprocedures,suchasmeniscusrepairormicrofracture,wereperformed.
PhaseI:114days
Goals
Protectgraftandgraftfixationwithuseofbraceandspecificexercises
Controlinflammationandswelling
Earlyrangeofmotion(ROM)withemphasisonfullextension,patellamobilizationsandflexion
Caution:avoidhyperextensiongreaterthan10
Educatepatientonrehabilitationprogression
Restorenormalgaitonlevelsurfaces
Brace
Postopbracewornlockedinextensionforambulationandsleeping
MayunlockforROMexercises
Weightbearingstatus
Weightbearingastoleratedwithcrutchesandbracelockedinextension
Ifmeniscalrepairormicrofracture,nonweightbearingfor4weeks
Exercises
ContinuousPassiveMotion(CPM)machine2hoursessions,3timesadayatslow,comfortablespeed.Startat
50offlexion,andincrease10perdayupto90
ROMexercises(seefiguresbelow)
Extensionnoactiveterminalextensionfrom40to0
Passiveextensionsitinachairandplaceyourheelontheedgeofastoolorchair;relaxthigh
musclesandletthekneesagunderit'sownweightuntilmaximumextensionisachieved.
Heelpropsplacerolleduptowelundertheheelandallowlegtorelax
Pronehangsliefacedownonatable/bedwiththelegshangingofftheedgeofthetable;allow
thelegstosagintofullextension.
Flexionlimitto90
Passiveflexionsitonchair/edgeofbedandletkneebendundergravity;mayusetheotherleg
tosupportandcontrolflexion
WallslidesLieonyourbackwiththeinvolvedfootonthewallandallowthefoottoslidedown
thewallbybendingtheknee;useotherlegtoapplypressuredownward.
HeelslidesUseyourgoodlegtopulltheinvolvedheeltowardthebuttocks,flexingtheknee.
Holdfor5seconds;straightenthelegbyslidingtheheeldownwardandholdfor5seconds.
Quadricepssetsinfullextension
Straightlegraisesinbracelockedinextension
Hamstringsets
Patellamobilization
Isometrichipabduction,adduction
AnkleROMandgastocsoleusstrengtheningwithtubing/therabands
PhaseII:Weeks36
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
Mayweanoutofpostbracewhendemonstrategoodquadcontrol
Weightbearingstatus
Weightbearingastolerated,weanoffcrutches
Exercises
Continueasabove,maintainingfullextensionandprogressingto125
Noactiveterminalextensionfrom40to0
Beginclosedkineticchainexercises
Stationarybicycling,stairmaster:slow,progressingtolowresistance
Hamstringcurls
Hipabduction,adduction,extension
At46weeks,partialsquats,usetableforsupport
PhaseIII:Weeks612
Goals
Fullactiverangeofmotion
Increasestrength
Exercises
Stationarybicycling,stairmaster,elliptical:increasesresistance
Treadmillwalking
Swimming,waterconditioning:flutterkickonly
Balanceandproprioceptivetraining
Closedchainquadstrengthening:nokneeflexiongreaterthan90withlegpress
PhaseIV:Months36
Goals
Improvestrength,enduranceandproprioception
Beginagilitytraining
Brace
FunctionalACLbrace
Exercises
Maystartjoggingprogram,forward/straightrunningonly
Continueandprogressstrengthening
Progresstorunningprogramat5months
Beginagilitytrainingat5months
o Side steps
o Crossovers
o Figure 8 running
o Shuttle running
o One leg and two leg jumping
o Cutting
o Acceleration/deceleration/sprints
o Agility ladder drills
Initiatesportspecificdrillsasappropriate
PhaseV:6monthspostop
Goals
Maintainstrength,enduranceandproprioception
Safereturntosport
Brace
FunctionalACLbraceforcontactsports,jumpingandlandingorcuttingandtwistinguntil1yearpostop,then
perpatientpreference
Exercises
Gradualreturntosportsparticipation
Maintenanceprogramforstrength,endurance
Returntosportscriteria
MDclearance
Fullrangeofmotion
Noswelling
Goodstabilityonligamenttesting
Fullstrengthcomparedtootherleg
Completedsportspecificfunctionalprogression
Runningandjumpingwithoutpainorlimp
EXERC
CISEFIGUR
RES
Heelprops
Pronehangs
Passiiveflexion
Wallslides
Heelslides
Straightlegraisess
Partialsquats
