ACL Reconstruction

Post-operative Period

0 to 1 month:

  1. 2 to 3 visits per week, everyday home program with goals

  2. Patellofemoral precautions throughout entire rehabilitation

  3. Prone lying, supine with logroll under ankle, and gentle stretching to achieve full hyper-extension

  4. Quad sets, may use electrical stimulation, increase # visit/week if quad inhibited

  5. Patellar mobilizations, especially superiorly. Cross friction massage/efflurage.

  6. Straight leg raises, full arc quads without weights

  7. Prone knee flexion, heel slides, calf and hamstring stretching, calf pumps

  8. 4-way hip and 4-way ankle exercises

  9. Icing or cryotherapy, 5 times a day and 20 minutes each before and after exercises

  10. Pt is to get full hyper-extension symmetrical to the contralateral knee within 4 wks of surgery (If not, contact Dr. Berkbigler)

  11. Pt is toe-touch weight bearing for 4 weeks

  12. Pt is to wear brace at all times when not at PT, 0 - 90°.

  13. Stationary bike with no resistance, seat elevated to within flexion range

1 to 2 months:

  1. 2 to 3 visits per week, 5 times a week home program with goals

  2. Pt may begin progression to full weight-bearing by 6 weeks

  3. Brace may be weaned off at 6 weeks with full motion allowed

  4. Continue all exercises in previous phase (as described above)

  5. Begin quad exercises including mini-squats, wall slide mini-squats, and partial arc quads (60 to 90 degrees) with light weights

  6. Hamstring isometric sets and hamstring curls with no weights

  7. Toe raises with weights, step-ups and step-downs (begin with 2 inches and progress to a full step)

  8. Progress proprioceptive/balance exercises including single-leg balance progression/wobble board

  9. If a pool is available, may start 4-way hip, lateral movement, deep water jogging in place, retro

  10. Crutches should be weaned off by this stage, and gait should be normal – if not, contact Dr. Berkbigler

  11. Range of motion should be full by 2 months. If any extension lag (compared to contralateral knee) or less than 125 degrees of flexion is present, please contact Dr. Berkbigler

2 to 4 months:

  1. 1 to 2 visits per week, mostly a home program 5 times a week, must review home program at each visit with goals.

  2. Continue exercises in previous phases (as described above)

  3. Focus rehabilitation towards more closed-chain exercises including leg presses (0 to 60 degrees), step-ups, mini-squats (0 to 60 degrees), short arc quads (30 to 90 degrees), and hamstring curls with light weights, high repetitions

  4. Endurance closed-chain quadriceps exercises should begin such as Stairmaster, stationary bike, elliptical trainer, Nordic trac (short stride), etc. Focus on increasing endurance and should be performed 3 to 4 times per week.

  5. Continue gait training, including progression to fast walking on a treadmill or even ground

  6. If a pool is available, swimming may started but the frog-kick and breaststroke should be avoided. Progress deep to shallow water jogging.

  7. Gait and range of motion should be normal by this phase. If it is not, contact Dr. Berkbigler

4 to 6 months:

  1. 4 to 5 times a week home program. May also have 2 visits per month to review home program with goals.

  2. Continue exercises in previous phases (as described above)

  3. Slow progression from fast walking to slow jogging on even ground or treadmill, or hill work. No cutting, jumping or pivoting

  4. Advance strengthening with weights including leg presses (0 to 90 degrees), step-ups, mini-squats (0 to 90 degrees), leg extensions (45 to 90 degrees), and leg curls (full motion). Repetitions should be smooth and slow and NOT explosive. May begin jump rope exercises. May advance swimming (no frog-kick or breaststroke).

6 to 12 months:

  1. 3 to 5 times a week home program. May need rehabilitative supervision for functional training.

  2. Begin advanced strengthening with weights including leg presses, leg extensions, squats, leg curls, and lunges

  3. Initiate plyometric program as appropriate for patient’s functional goals

  4. May begin functional training exercises including fast straight running, backward running, cutting, cross-overs, carioca, etc.

  5. Begin gradual return to previous sports/activities/work duties under controlled conditions

  6. Full return to sports/activities/full work duties are pending Dr. Berkbigler’s approval based upon the following criteria:

Criteria for Return to Sports/Full Activities:

  1. Quadriceps and hamstring strength at least 90% of opposite leg

  2. One-leg hop test and vertical jump at least 90% of opposite leg

  3. Jog, full speed run, shuttle run, and figure of 8 running without a limp

  4. Full controlled acceleration and deceleration

  5. Squat and rise from a full squat

  6. No effusion or quadriceps atrophy