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.


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

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

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