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ACLReconstructionPostOperativeRehabilitationProtocol

ThefollowingisageneralizedoutlineforrehabilitationfollowingACLreconstruction.Theprotocolmaybemodifiedif
additionalprocedures,suchasmeniscusrepairormicrofracture,wereperformed.

PhaseI:114days
Goals

Protectgraftandgraftfixationwithuseofbraceandspecificexercises
Controlinflammationandswelling
Earlyrangeofmotion(ROM)withemphasisonfullextension,patellamobilizationsandflexion
Caution:avoidhyperextensiongreaterthan10
Educatepatientonrehabilitationprogression
Restorenormalgaitonlevelsurfaces

Brace

Postopbracewornlockedinextensionforambulationandsleeping
MayunlockforROMexercises

Weightbearingstatus

Weightbearingastoleratedwithcrutchesandbracelockedinextension
Ifmeniscalrepairormicrofracture,nonweightbearingfor4weeks

Exercises

ContinuousPassiveMotion(CPM)machine2hoursessions,3timesadayatslow,comfortablespeed.Startat
50offlexion,andincrease10perdayupto90
ROMexercises(seefiguresbelow)
Extensionnoactiveterminalextensionfrom40to0
Passiveextensionsitinachairandplaceyourheelontheedgeofastoolorchair;relaxthigh
musclesandletthekneesagunderit'sownweightuntilmaximumextensionisachieved.
Heelpropsplacerolleduptowelundertheheelandallowlegtorelax
Pronehangsliefacedownonatable/bedwiththelegshangingofftheedgeofthetable;allow
thelegstosagintofullextension.
Flexionlimitto90
Passiveflexionsitonchair/edgeofbedandletkneebendundergravity;mayusetheotherleg
tosupportandcontrolflexion
WallslidesLieonyourbackwiththeinvolvedfootonthewallandallowthefoottoslidedown
thewallbybendingtheknee;useotherlegtoapplypressuredownward.

HeelslidesUseyourgoodlegtopulltheinvolvedheeltowardthebuttocks,flexingtheknee.
Holdfor5seconds;straightenthelegbyslidingtheheeldownwardandholdfor5seconds.
Quadricepssetsinfullextension
Straightlegraisesinbracelockedinextension
Hamstringsets
Patellamobilization
Isometrichipabduction,adduction
AnkleROMandgastocsoleusstrengtheningwithtubing/therabands

PhaseII:Weeks36
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

Mayweanoutofpostbracewhendemonstrategoodquadcontrol

Weightbearingstatus

Weightbearingastolerated,weanoffcrutches

Exercises

Continueasabove,maintainingfullextensionandprogressingto125
Noactiveterminalextensionfrom40to0
Beginclosedkineticchainexercises
Stationarybicycling,stairmaster:slow,progressingtolowresistance
Hamstringcurls
Hipabduction,adduction,extension
At46weeks,partialsquats,usetableforsupport

PhaseIII:Weeks612
Goals

Fullactiverangeofmotion
Increasestrength

Exercises

Stationarybicycling,stairmaster,elliptical:increasesresistance
Treadmillwalking
Swimming,waterconditioning:flutterkickonly
Balanceandproprioceptivetraining
Closedchainquadstrengthening:nokneeflexiongreaterthan90withlegpress


PhaseIV:Months36
Goals

Improvestrength,enduranceandproprioception
Beginagilitytraining

Brace

FunctionalACLbrace

Exercises

Maystartjoggingprogram,forward/straightrunningonly
Continueandprogressstrengthening
Progresstorunningprogramat5months
Beginagilitytrainingat5months
o Side steps
o Crossovers
o Figure 8 running
o Shuttle running
o One leg and two leg jumping
o Cutting
o Acceleration/deceleration/sprints
o Agility ladder drills
Initiatesportspecificdrillsasappropriate

PhaseV:6monthspostop
Goals

Maintainstrength,enduranceandproprioception
Safereturntosport

Brace

FunctionalACLbraceforcontactsports,jumpingandlandingorcuttingandtwistinguntil1yearpostop,then
perpatientpreference

Exercises

Gradualreturntosportsparticipation
Maintenanceprogramforstrength,endurance

Returntosportscriteria

MDclearance
Fullrangeofmotion
Noswelling
Goodstabilityonligamenttesting
Fullstrengthcomparedtootherleg
Completedsportspecificfunctionalprogression
Runningandjumpingwithoutpainorlimp

EXERC
CISEFIGUR
RES

Heelprops

Pronehangs

Passiiveflexion


Wallslides

Heelslides

Straightlegraisess

Partialsquats