ACL Reconstruction Rehabilitation Protocol

WEEK 1:

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

WEEK 2:

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

WEEKS 3-4:

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

WEEKS 4-6:

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

WEEKS 6-8:

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

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

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