Anterior Cruciate Ligament (ACL) Repair Rehabilitation Protocol - For ACL Repair, not ACL Reconstruction
General Considerations:
• Passive and active range of motion between 30 - 70° for 4 weeks. Patient will be instructed to come out of the brace once a day for extension range of motion stretching beginning Week 2.
• Crutch-assisted weight bearing progressing to full as tolerated.
• Regular attention should be paid to the incisions to decrease fibrosis and scarring with particular emphasis on the anterior and lateral incisions.
• Exercises and manual treatments should also focus on early quadriceps and VMO recruitment.
• Patients are given a functional assessment/sport test at 3, 4, and 6 months post-op.
Photo: Knee Range of Motion with 30° Flexion
Week 1:
• MD visit on Day 1 to change dressing and review home program.
• Icing and elevation as much as able.
• Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets, gait training, passive and active range of motion exercises within guidelines.
• Balance and proprioception exercises.
• Soft tissue treatments and gentle mobilization to posterior musculature, patella, and incisions.
Photos: Patellar Mobilization
Weeks 2 - 4:
• MD visit at 8 - 10 days.
• Incorporate functional exercises (i.e. squats/knee bends, modified lunges, step-ups).
• Instruct on once a day, passive extension stretching.
• Continue with pain control, range of motion, gait training, soft tissue treatments, and balance & proprioception exercises.
• Pool workouts after the incisions are healed and with the use of the brace.
• Aerobic exercises as ROM allows (i.e. elliptical, UBE, Versaclimber).
Photo: Countertop Squats Static Lunges (perform without weights)
Weeks 4 - 6:
• MD visit at 4 weeks, will discontinue use of post-op brace at that time (may wean off brace with full range of motion if no significant weakness or apprehension).
• Push for full range of motion with emphasis on extension.
• Increase intensity of all exercises with focus on closed-chain, functional progression.
• Stationary and road cycling as tolerated.
Closed-chain Exercise Examples
Photos: Ball Feet Bridges Head on Ball Bridges
Photos: Plank and Leg Press
Weeks 6 - 8:
• Continue to increase the intensity of exercises (i.e. stretch cord resistance, adding
weight, increasing resistance of aerobic machines).
• Add lateral training exercises.
• Begin to incorporate sport- or activity-specific training.
Photos: SportCord Forward Walking and SportCord Side Walking
Photos: Theraband Sidewalks - start and walk positions
Weeks 8 - 15:
• Progression of program of increasing intensity to return to sports and activities of daily living.
• Incorporate bilateral jumping exercises once able to demonstrate adequate strength. Watch for compensatory patterns with take-offs or landings.
Weeks 12 - 20:
• Patients are not scheduled for another MD appointment until 3 - 4 months post-op.
• At this point, range of motion should be at or near 100% and any restrictions or concerns should be communicated to our office.
NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.
General Considerations:
• Passive and active range of motion between 30 - 70° for 4 weeks. Patient will be instructed to come out of the brace once a day for extension range of motion stretching beginning Week 2.
• Crutch-assisted weight bearing progressing to full as tolerated.
• Regular attention should be paid to the incisions to decrease fibrosis and scarring with particular emphasis on the anterior and lateral incisions.
• Exercises and manual treatments should also focus on early quadriceps and VMO recruitment.
• Patients are given a functional assessment/sport test at 3, 4, and 6 months post-op.
Photo: Knee Range of Motion with 30° Flexion
Week 1:
• MD visit on Day 1 to change dressing and review home program.
• Icing and elevation as much as able.
• Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets, gait training, passive and active range of motion exercises within guidelines.
• Balance and proprioception exercises.
• Soft tissue treatments and gentle mobilization to posterior musculature, patella, and incisions.
Photos: Patellar Mobilization
Weeks 2 - 4:
• MD visit at 8 - 10 days.
• Incorporate functional exercises (i.e. squats/knee bends, modified lunges, step-ups).
• Instruct on once a day, passive extension stretching.
• Continue with pain control, range of motion, gait training, soft tissue treatments, and balance & proprioception exercises.
• Pool workouts after the incisions are healed and with the use of the brace.
• Aerobic exercises as ROM allows (i.e. elliptical, UBE, Versaclimber).
Photo: Countertop Squats Static Lunges (perform without weights)
Weeks 4 - 6:
• MD visit at 4 weeks, will discontinue use of post-op brace at that time (may wean off brace with full range of motion if no significant weakness or apprehension).
• Push for full range of motion with emphasis on extension.
• Increase intensity of all exercises with focus on closed-chain, functional progression.
• Stationary and road cycling as tolerated.
Closed-chain Exercise Examples
Photos: Ball Feet Bridges Head on Ball Bridges
Photos: Plank and Leg Press
Weeks 6 - 8:
• Continue to increase the intensity of exercises (i.e. stretch cord resistance, adding
weight, increasing resistance of aerobic machines).
• Add lateral training exercises.
• Begin to incorporate sport- or activity-specific training.
Photos: SportCord Forward Walking and SportCord Side Walking
Photos: Theraband Sidewalks - start and walk positions
Weeks 8 - 15:
• Progression of program of increasing intensity to return to sports and activities of daily living.
• Incorporate bilateral jumping exercises once able to demonstrate adequate strength. Watch for compensatory patterns with take-offs or landings.
Weeks 12 - 20:
• Patients are not scheduled for another MD appointment until 3 - 4 months post-op.
• At this point, range of motion should be at or near 100% and any restrictions or concerns should be communicated to our office.
NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.
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