The following is a generalized outline for rehabilitation following ACL reconstruction. The protocol may be modified if additional procedures, such as meniscus repair or microfracture, were performed.
Phase I: 1 – 14 days Goals:
- Protect graft and graft fixation with use of brace and specific exercises.
- Control inflammation and swelling.
- Early range of motion (ROM) with emphasis on full extension, patella mobilizations and flexion.
Post op brace worn locked in extension for ambulation. May unlock for ROM exercises.
Weight bearing status: Weightbearing as tolerated with crutches and brace locked in extension. If meniscal repair or microfracture, nonweightbearing for 4 weeks.
Quadriceps sets in full extension
- Restore normal gait with stair climbing
- Maintain full extension, progress toward full flexion range of motion
- Protect graft and graft fixation
- Increase hip, quadriceps, hamstring and calf strength
- Increase proprioception
Continue as above, maintaining full extension and progressing to 125 degrees Begin closed kinetic chain exercises Stationary bicycling,
stairmaster: slow, progressing to low resistance Hamstring curls Hip abduction, adduction, extension, side lifting, heel raises
At 4‐ 6 weeks, wall squats
- Full active range of motion
- Increase strength
Stationary bicycling, stairmaster, elliptical: increases resistance Treadmill walking Swimming, water conditioning: flutter kick only
Balance and proprioceptive training
Closed chain quad strengthening: no knee flexion greater than 90 degrees with leg press
- Improve strength, endurance and proprioception Begin agility training Exercises
- May start jogging program, forward/straight running only
- Continue and progress strengthening
- Progress to running program at 5 months
- Begin agility training at 5 months
- Side steps
- Cross overs
- Figure 8 running o Shuttle running o One leg and two leg jumping o Cutting o Acceleration / deceleration / sprints / agility ladder drills
- Initiate sport‐specific drills as appropriate
Phase V: 6 months post‐op Goals:
- Maintain strength, endurance and proprioception
- Safe return to sport Exercises
- Gradual return to sports participation
- Maintenance program for strength, endurance
Return to sports criteria: Full range of motion No swelling Good stability on ligament testing Full strength compared to other leg Completed sport‐specific functional progression Running and jumping without pain or limp