ACL Reconstruction + Meniscus Repair Rehabilitation
WEEK 1:
Weight Bearing
- 50% partial weight bearing when ambulating
- No weight bearing at all in flexion angles >90°
Brace
- Locked at 0° extension
- OK to remove for hygiene and exercises
- Wear at night
ROM
- 0 – 90°
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
WEEK 2:
Weight Bearing
- 50% partial weight bearing when ambulating
- No weight bearing at all in flexion angles >90°
Brace
- Locked at 0° extension
- OK to remove for hygiene, exercises AND SLEEP
ROM
- 0 – 90° when weight bearing
- PROM as tolerated when not bearing weight
Therapeutic Exercise
- Flexion: wall slides, heel slides, sitting flexion
- Extension: Passive knee extension using towel roll, prone hangs
- 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
- Trunk stabilization
- Manual Interventions: patellar mobs, tibiofemoral mobs into extension, soft tissue as indicated
WEEKS 3-4:
Weight Bearing
- Continue to ambulate with crutches, but may begin to advance weight bearing to 75%
- No weight bearing at all in flexion angles >90°
Brace
- Brace unlocked, with ROM set to 0-90° for ambulation
- OK to remove for hygiene, exercises AND SLEEP
ROM
- Increase flexion PROM 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 leg extensions 90-40 degrees without weight
- Closed Kinetic Chain: step ups, heel raises progressing to single leg
- Single leg standing
- Hamstring PREs
- Manual interventions, modalities and trunk stabilization exercises
WEEKS 4-6:
Weight Bearing
- Continue crutches
- Advance to full weight bearing, but with crutches
- No weight bearing at all in flexion angles >90°
Brace
- Gradually discontinue brace use
ROM
- Full active and passive extension
- Flexion within approx. 10° of uninvolved leg
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 leg extensions 90-40 degrees without weight
- Closed Kinetic Chain: step ups, heel raises progressing to single leg
- Single leg standing
- Hamstring PREs
- Manual interventions, modalities and trunk stabilization exercises
WEEKS 6-8:
Weight Bearing
- Full weight bearing
- Gradually discontinue crutch use
- No weight bearing at all in flexion angles >90°
Brace
- None
ROM
- Full active and passive extension and flexion ROM
Therapeutic Exercise
- Begin Stationary Bike
- Progress intensity of strengthening program, stair climber, walking incorporating single leg activities
- Lunges 0-90°
- Leg press 0-90°
- Functional Goals: reciprocal stair ascending, walking with normal gait pattern
- Progress intensity of strengthening program incorporating single leg activities
WEEKS 8-12:
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
WEEKS 12+:
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
