ACL Reconstruction Rehab Protocol

Dr. Eierle

Overview

Phase / Timeline / General Plan
1 / 0-2 weeks / pain control, swelling control, wound stability, maintenance of full extension, quadriceps control
2 / 2-6 weeks / maximizing flexion, graft protection while continued quadriceps/ hamstring strengthening
3 / 6-12 weeks / Normal motion (if not yet achieved), continued strengthening/ proprioception
4 / 3-6 months / Continued progression…slow advance to jog/run by 5 months (no cutting/pivoting)
5 / 9-12 months / Return to full sports (dependent on preop activity, postop activity, graft)

Phase Specific Rehabilitation

Phase / Timeline / ROM/Cardio / Strengthening / Functional Exercise
1 / 0-2 weeks / FOCUS: full extension
goal 0-90 by 2 weeks
PROM/AAROM only
patellar mobs / isometric quads
progress to straight leg raises
ankle pumps
progress to standing heel rises / Weight-bearing as tolerated (with immobilizer or ROM brace locked in extension)
crutches
dressing change on POD3 then as needed
ice, Ace wrap for swelling
2 / 2-6 weeks / discontinue immobilizer (if given)
focus on full ext. if not yet achieved
goal 0-120
start AROM
start station bike (no resist)
patellas mobs / continue phase 1 strengthening
SLR, heel rises
progress to light leg press (0-45 degrees, 25% BW) / Full weight bearing without crutches
ROM brace until good leg control when walking
walk without limp
wall squats
start BAPS
3 / 6-12 weeks / goal 0-130
stationary bike (progress resist., progress time to 15 min) / Leg extension, leg press
hamstring curls (progress weight
SLOWLY)
no resistance > 90 deg flex / Bicycling
closed chain activity
Gait training, figure of 8 walking,
Sidestepping
wall squats
BAPS
4 / 3-6 months / full ROM / add squats
(max 90 deg knee flexion) / transition to open chain activity
swim – OK
run - usually no earlier than 4-5 months double leg hop
lunges
Criteria for D/C from rehab (usually by 6 months)
normal knee ROM (0-130), no patellafemoral pain, able to single leg hop, quad/HS strength >80% contralateral side
After D/C from rehab
return to full duty, light sports (no cutting/pivoting)
5 / 9-12 months / return to full sports

*** Phases for rehab and their timelines are GUIDELINES with the EXCEPTION being the need to protect the graft for the first 6 weeks postop.

Special cases

ACLR + meniscal repair / no flexion > 90 deg AND no resisted flexion for 6 weeks postop
no squatting > 90 deg for 16 weeks postop
ACLR + meniscectomy / no additional restrictions
ACLR + OCD microfx/OATS / non-weightbearing AND no resisted motion for 6 weeks postop
consider CPM

Last updated 3/16/2009 cceierle