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REHABLITATION

ACL Reconstruction Rehab Protocol

General considerations

  • Progression ought to be based on careful monitoring by the Physical Therapist of the patient's useful status.
  • Early emphasis on achieving full extension equal to the opposite side (including hyperextension within normal range, 10*).
  • Avoid direct palpation and mobilization on incisions/portals for 5 weeks.
  • No cutting or twisting until then cleared by Sports Test I.
  • No resisted leg extension machines (isotonic or isokinetic) at any point in the rehab process.
  • Patient should be well conscious that healing and tissue maturation continue to take place for 1 year after surgery.
  • Patients are given Sports Test I at 3 months, Sports Test II at 6 months, Sports Test III at 1 year.

Weeks 1 - 2

  • Nurse apt on day 2 for dressing change and review of home-based program.
  • Ice/elevation every 2 hours for 15 minutes to minimize edema and increase healing (please refer to Icing handout).

Manual

  • Bland tissue treatment to quads,popliteal fossa, suprapatellarpouch, iliotibialband and Hoffa’s fat pad. Extensive patellar mobilization.
  • No direct scar mobilization x 5weeks.

Exercises

  • Seated edge of bed dangles for knee flexion; prop for knee extension.
  • Gait training progression towards minimizing Assistive Devices (walker, crutches, etc).
  • Upper body conditioning, well-leg stationary cycling or Upper Body Ergometer.
  • Quad sets/straight leg raises, hip abduction, calf presses, glut sets, and core exercises.

Goals

  • Range of motion: 0-90 degrees.
  • Gait weight-bearing as tolerated.
  • Pain < 3/10. Minimal Edema.
  • Good quality gait with least amount of Assistive Device.

Weeks 2 - 4

  • Suture removal on day 12-15.
  • Walking for exercise for 20-25 minutes if no limp or swelling present.

Manual

  • No direct scar mobilization x 4weeks.
  • Extensive patellar mobilization.

Exercises

Range of motion and functional strengthening exercises:

  • Squats/Leg Press, Bridges/Hamstring Curls.
  • 2” step up/down, acute core training.

Goals

  • Active range of motion equal extension to uninvolved side and flexion to 120 degrees. No edema. Full weight-bearing; general gait without assistive device. Single leg balance 60 seconds on level surface.

Weeks 4 - 6

  • Walk up to 1 hour for work out.

Exercises

  • Emphasize self-stretching to both lower extremities.
  • Increase intensity of resistance activities (i.e. standing resisted squats, lunges, etc.).
  • Increase single leg potency, challenge proprioceptive training.

Goals

  • Full Range Of Motion equivalent to uninvolved leg.
  • Perform 4 inch step down.
  • Bike with minimal resistance for 20-30 minutes (in saddle), Elliptical ,walking for 30 minutes, water-walking.

Weeks 6 - 10

Manual

  • Soft tissue mobilization and joint mobilization as required.

Exercises

  • Add lateral training Works out (lateral step ups, step overslunges).
  • Initiate tri-planar activities with the exception of closed-chain rotation (pivots).
  • No pivoting or cutting.

Goals

  • Activities should be pain-free.
  • Able to dismount stairs, double leg squat hold for >1 minute.
  • Bike >30 minutes with medium resistance, Elliptical with interval training, Flutter-style for swimming (no flippers, no breast-stroke kick).

Weeks 10 - 16

  • MD visit at 3 months
  • Complete game Test I and return to pre-running program at 3 months (see handout for specific details)
  • Incorporate bilateral, low level jumping exercises.
  • Fit for functional knee brace
  • Continue to increase strength, endurance, and add sport specific training drills.

Goals

  • Pass Sports Test I.

Weeks 16+

  • MD visit at 6 months.
  • Sport test 2 at 5 months. Begin return to run program.
  • Implementation of jump training, activity training. Education of “at risk sports”.
  • After 6 months add lateral plyometric type drills, agility ladder.

Goals

  • Start sagittal plane plyometric, work towards single leg plyometric. Clearance by MD and pass Sports metric training before returning to full athletics.

NOTE: All progresses are approximations and should be used as a guideline only. Development will be based on individual patient presentation, which is assessed throughout the treatment method.