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ACL Reconstruction Rehab Protocol


normal acl scope picture

arthroscopic ACL reconstruction picture

acl reconstruction xray picture

  • Decrease swelling, Normalize gait, strength and ROM.
  • Extension: prone hangs or heel props (7-10 min)
  • Flexion:  wall slides, heel slides, active assist flexion
  • Weight bearing as tolerated
  • Treadmill: forward/backward (5-10min)
  • Closed chain: leg press, total gym (10-50 deg), toe raisesOpen chain:
  • Quad machine (90-30 deg), hamstring machine
  • 4-way SLR.  All exercises 3-5 sets, 12-15 reps
  • Electrical stimulation for VMO PRN
  • Low-impact activities (bike, treadmill walking)
  • Ice/elevation: 20 min on/60 min off
  • Passive extension/flexion activities
  • Lower extremity strengthening as indicated
  • All activities 3-4 times/day or as indicated

Postoperative (Days 1-14)

  • Control swelling, restore ROM, normalize gait and strength                                    
  • Ace wrap with elevation-ankle pumps (20 min)
  • Extension: heel props (7-10 min), or prone hangs
  •  Flexion:  heel slides (7-10 min), advancing to wall slides, active assist flexion
  • *avoid lying with pillow under knee*
  • Weight bearing as tolerated
  • SLR, quad sets, glute sets, hamstring sets
  • As above 4-5 times/day while at home
  • Treadmill:  forward/backward (5-10 min)
  •  Calf, hamstring, hip flexor stretching (3 times,
  • 30 sec hold)  *emphasize heel to toe gait*
  • 4-way SLR, quad sets, multi-angle isometrics (0-45-90 deg)         
  • Electrical muscle stimulation PRN (15 min)
  •  Partial squat (10-40 deg), toe raises with assistance PRN
  • All exercises 3-5 sets, 12-15 reps
  • Total Gym Level 1-3

Postoperative (Weeks 2-5)      

  • Full passive knee extension and flexion      
  • Extension: prone hangs or heel props (0-125 by 4 wks)
  • Flexion:  wall slides, heel slides, active assist flexion, bike (7-10 min)
  • Treadmill: forward/backward (5-10 min)
  • Increase grade with treadmill as tolerated
  • Calf, hamstring, hip flexor stretching (3 times 30 sec hold)
  • Closed chain: leg press (10-50), Total gym level (4-5)
  • Push FROM without pain hamstring stretch, 4-way SLR,
  • Toe raises, step ups, mini squats
  • All exercises 3-5 sets, 12-15 reps
  • *Implement within painfree ROM once normal gait and effusion control are achieved
  • HS curls start at – 2 weeks for bone–patella–bone grafts and  4 weeks for HS grafts.
  •  Initiate proprioception exercises (pain-free) 
  • BAPS (start with ball 1 sitting and progress to standing-4 min)
  • Double leg stand with rebounder
  • Single leg stance/grid exercises (lunges, reaches)
  • Standing 4-way hip theratubing exercises
  • Lateral treadmill walking both directions
  • Implement once patient is able to ambulate normally without pain (3-5 min)

Postoperative (Week 6-12)

  • Criteria for progression:No effusion, painless full ROM, minimal crepitus.  Score greater than 80 on Lysholm with no locking or instability, painfree low impact activity (bike, treadmill, walking, stepper on own)
  •  3-4 times per week, 20-30 minutes
  • Trampoline hopping bilaterally progressing to jogging, then single leg hopping (10 min)
  • Fitter with ski poles progressing to no ski poles (7-10 minutes)  BAPS – single leg
  • Body blade Proprioceptive Star Excercises
  • Week 10 – Light double leg hopping
  • (multi-directional), lateral shuffles
  • Total gym level 8-10 without pain, leg press (10-50), toe raises, step ups
  • Hamstring machine, 4-way SLR
  • All exercises 3-5 sets, 12-15 reps Mini squats, Partial lunges,  single-leg toe raise

Postoperative (Week 13-24)       

  • Criteria for progression: no effusion, painless full ROM,  minimal crepitus.  Score great than 90 on Lysholm with no locking or instability Ratio of 80% involved to uninvolved on isokinetic test at 6 months post-op . Ratio of 80% on one-legged jump. Pain free low impact activity (bike, treadmill, walking, stepper) 
  • 3-4 times per week, 20-30 minutes
  • Closed chain: leg press (10-50 deg), Toe raises.  Total gym level 8-10 without pain.
  • Open chain:  Quad machine (90-30 deg),  Hamstring machine
  • All exercise’s 3 sets 15-20 each
  • Walk/jog cycles: 3-5 min warm-up (walk); 10-30 sec jog/60 sec walk for 10-20 min; 3-5 min cool-down (walk). Gradually increase jog time and decrease walk time based upon patient response.
  • Progressive strength training and agility/speed drills
  • Program should be based upon specific patient needs / sport.
  • Return to sport UPMC guidelines.



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