ACL Reconstruction Rehab Protocol
- Progression ought to be based on careful monitoring by the Physical Therapist of the patient's useful status.
- Early emphasis on achieving full extension equal to the opposite side (including hyperextension within normal range, 10*).
- Avoid direct palpation and mobilization on incisions/portals for 5 weeks.
- No cutting or twisting until then cleared by Sports Test I.
- No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
- Patient should be well conscious that healing and tissue maturation continue to take place for 1 year after surgery.
- Patients are given Sports Test I at 3 months, Sports Test II at 6 months, Sports Test III at 1 year.
Weeks 1 - 2
- Nurse apt on day 2 for dressing change and review of home-based program.
- Ice/elevation every 2 hours for 15 minutes to minimize edema and increase healing (please refer to Icing handout).
- Bland tissue treatment to quads,popliteal fossa, suprapatellarpouch, iliotibialband and Hoffa's fat pad. Extensive patellar mobilization.
- No direct scar mobilization x 5weeks.
- Seated edge of bed dangles for knee flexion; prop for knee extension.
- Gait training progression towards minimizing Assistive Devices (walker, crutches, etc).
- Upper body conditioning, well-leg stationary cycling or Upper Body Ergometer.
- Quad sets/straight leg raises, hip abduction, calf presses, glut sets, and core exercises.
- Range of motion: 0-90 degrees.
- Gait weight-bearing as tolerated.
- Pain < 3/10. Minimal Edema.
- Good quality gait with least amount of Assistive Device.
Weeks 2 - 4
- Suture removal on day 12-15.
- Walking for exercise for 20-25 minutes if no limp or swelling present.
- No direct scar mobilization x 4weeks.
- Extensive patellar mobilization.
Range of motion and functional strengthening exercises:
- Squats/Leg Press, Bridges/Hamstring Curls.
- 2” step up/down, acute core training.
- Active range of motion equal extension to uninvolved side and flexion to 120 degrees. No edema. Full weight-bearing; general gait without assistive device. Single leg balance 60 seconds on level surface.
Weeks 4 - 6
- Walk up to 1 hour for work out.
- Emphasize self-stretching to both lower extremities.
- Increase intensity of resistance activities (i.e. standing resisted squats, lunges, etc.).
- Increase single leg potency, challenge proprioceptive training.
- Full Range Of Motion equivalent to uninvolved leg.
- Perform 4 inch step down.
- Bike with minimal resistance for 20-30 minutes (in saddle), Elliptical ,walking for 30 minutes, water-walking.
Weeks 6 - 10
- Soft tissue mobilization and joint mobilization as required.
- Add lateral training Works out (lateral step ups, step overslunges).
- Initiate tri-planar activities with the exception of closed-chain rotation (pivots).
- No pivoting or cutting.
- Activities should be pain-free.
- Able to dismount stairs, double leg squat hold for >1 minute.
- Bike >30 minutes with medium resistance, Elliptical with interval training, Flutter-style for swimming (no flippers, no breast-stroke kick).
Weeks 10 - 16
- MD visit at 3 months
- Complete game Test I and return to pre-running program at 3 months (see handout for specific details)
- Incorporate bilateral, low level jumping exercises.
- Fit for functional knee brace
- Continue to increase strength, endurance, and add sport specific training drills.
- Pass Sports Test I.
- MD visit at 6 months.
- Sport test 2 at 5 months. Begin return to run program.
- Implementation of jump training, activity training. Education of "at risk sports".
- After 6 months add lateral plyometric type drills, agility ladder.
- Start sagittal plane plyometric, work towards single leg plyometric. Clearance by MD and pass Sports metric training before returning to full athletics.
NOTE: All progresses are approximations and should be used as a guideline only. Development will be based on individual patient presentation, which is assessed throughout the treatment method.