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.

Brace:
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.

Exercises

ROM exercises:

Passive extension – sit in a chair and place your heel on the edge of a stool or chair; relax thigh muscles and let the knee sag under its own weight until maximum extension is achieved.
Heel props – place rolled up towel under the heel and allow leg to relax
Flexion – limit to 90 degrees
Passive flexion – sit on chair/edge of bed and let knee bend under gravity; may use the other leg to support and control
flexion Heel slides – Use your good leg to pull the involved heel toward the buttocks, flexing the knee. Hold for 5 seconds; straighten the leg 2 sliding the heel downward and hold for 5 seconds.

Quadriceps sets in full extension

Ankle ROM

Phase II: Weeks 3 – 6 Goals:
  • 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
Brace: May wean out of brace when you demonstrate good quadriceps control
Weightbearing status: Weightbearing as tolerated, wean off crutches

Exercises
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

Phase III: Weeks 6 – 12 Goals:
  • Full active range of motion
  • Increase strength

Exercises
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

Phase IV: Months 3 – 6 Goals:
  • 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