ACL Reconstruction Rehabilitation Protocol

Weight Bearing

• Weight bearing to tolerance, unless otherwise specified

Brace

• Locked at 0^° extension until adequate quad control

ROM

• As tolerated

Therapeutic Exercise

• Flexion: wall slides, heel slides to patient tolerance
• Extension: Passive knee extension using towel roll, prone hangs
• Strengthening: Quad setting with knee support, hamstring digs with knee support, plantarflexion/ dorsiflexion, eversion/inversion strengthening

Weight Bearing

• Weight bearing with assistive devices as needed

Brace

• Unlock brace when quad control is adequate for knee support

ROM

• As tolerated, goal for knee flexion is 90^°

Therapeutic Exercise

• Flexion: wall slides, heel slides, sitting flexion
• Extension: Passive knee ext using towel roll, prone hangs
• Bike
• Open kinetic chain: straight leg raise, Hip abd/adduction, hip extension, hamstring set or prone hamstring curl
• Closed Kinetic Chain: Heel raises, leg press with minimal resistance, weight shifting onto single leg
• Trunk stabilization
• Manual Interventions: patellar mobs, tibiofemoral mobs into extension, soft tissue as indicated

Weight Bearing

• Achieve full weight bearing without assistive device with functional gait

Brace

• None

ROM

• Increase flexion ROM approx. by 10^° per week
• Achieve and maintain full passive and active extension

Therapeutic Exercise

• Open Kinetic Chain: Straight leg raises into flexion with emphasis on endurance of quadriceps and full knee extension
• Open Kinetic Chain: Hip strengthening and hamstring curls
• Open Kinetic Chain: Short arc quadriceps extension
• Closed Kinetic Chain: leg press (increasing resistance, progress to single leg), partial squat to 60^°, step ups, heel raises progressing to single leg
• Manual interventions, modalities and trunk stabilization exercises

Weight Bearing

• Gradually discontinue crutch use

Brace

• None

ROM

• Full active and passive extension
• Flexion within approx. 10^° of uninvolved leg

Therapeutic Exercise

• Closed Kinetic Chain: step downs, single leg balance, terminal active knee extension to 0^° against resistance, full squat to 90^°, single leg squat, elliptical, treadmill walking if gait pattern is functional
• Functional Goals: reciprocal stair ascending, walking with normal gait pattern

Weight Bearing

• Full weight bearing

Brace

• None

ROM

• Full active and passive extension and flexion ROM

Therapeutic Exercise

• Progress intensity of strengthening program incorporating single leg activities
• Cardio activities: elliptical, treadmill, stair climber, walking outdoors, or uneven surfaces
• Closed Kinetic Chain: step downs, lateral step/down, sustained squat side stepping

Weight Bearing

• Full weight bearing

Brace

• None

ROM

• Full and pain free range of motion

Therapeutic Exercise

• Jumping activities on gravity eliminated shuttle (progress to single leg)
• Jogging on trampoline
• Dynamic single/double leg functional exercises as anticipated for sport activity

Weight Bearing

• Full weight bearing

Brace

• None

ROM

• Full and pain free range of motion

Therapeutic Exercise

• Progress to running when: 90% of quadriceps strength as measured, single leg squat depth, hop Testing, single leg balance duration
• Return to running: treadmill walk/run intervals, treadmill running, track running (run straight, walk turns), track running full, road running
• Agility and plyometric exercises
• Lateral and cutting maneuvers