ACL repair rehab protocol

General Considerations

• Passive and active range of motion between 30 - 70 degrees for 4 weeks. Brace will set to this range of motion.

*Avoid any extension beyond 30 degrees for 2 weeks post-op. OK to stretch into flexion per patient comfort 2x/day immediately post-op. At 2 weeks post-op, come out of the brace twice a day for extension (straightening) and flexion (bending) range of motion stretching to full range as tolerated. Hold each stretch for 1 minute. Do 2 sets of 1 minute each time (therefore 4 sets of extension per day and 4 sets of flexion per day). Remove brace for stretching.

• Crutches to assist weight bearing progressing to full as tolerated with brace.
• Patient to wear knee brace while sleeping for 4 weeks post-op.
• Soft tissue mobilizations to the incisions to decrease fibrosis and scarring; portals must be completely closed and authorization must be obtained from Dr. Stone (s/p 4 weeks)
• Exercises should focus on early muscular recruitment.
• Begin physical therapy as soon as able for soft tissue mobilization, anti-inflammatory modalities, and general conditioning.
• Patients are given a functional assessment/sport test at 3 months, 6 months, 1 year.

Week 1

• Nurse visit day 2 to change dressing and review home program.
• Icing and elevation as per icing protocol (please see handout for full details).

Manual

• Soft tissue treatments, gentle mobilization to posterior musculature and patella. No portal mobilizations at this time.

Exercises

• Leg raises (30 degrees of knee bend with brace on) (lying, seated, and standing), quadriceps/adduction/gluteal sets, passive and active range of motion exercises within guidelines, well-leg stationary cycling.
• Gait training to normalize walking pattern.
• Balance and proprioception exercises.

Goals

• Decrease pain.
• Weight bearing as tolerated with brace.
• Passive range of motion 30-70 degrees x 4 weeks.

Weeks 2 - 4

• Nurse visit at Day 14 for stitch removal.

Manual

• Continue with effleurage, soft tissue treatments, patellar glides, and passive range of motion.

Exercises

• Incorporate progressive and gentle functional exercises (squats/knee bends, modified lunges, step-ups). Continue with pain control, range of motion, gait training, balance/proprioception and soft tissue treatments. Begin pool workouts after the incisions are healed and with the use of the brace. Begin two-legged aerobic exercises as range of motion allows (VersaClimber, stair machine, upper body ergometer, NordicTrac).

Goals

• Minimal edema, decrease pain.
• Weight bearing as tolerated with brace.
• Range of motion 30-70 degrees x 4 weeks.

Weeks 4 - 6

• M.D. visit at 4 weeks, will discontinue use of post-op brace at that time
• May wean off brace with full range of motion if significant weakness or apprehension is present.

Manual

• Push for full range of motion with emphasis on extension. Continue soft tissue mobilization, joint mobilizations as needed. Initiate scar mobilization once incisions closed.

Exercises

• Increase intensity of all exercises with focus on closed-chain, functional progression. -Stationary and road cycling as tolerated.

Goals

• Range of motion 0-110 degrees.
• Gait no brace, good mechanics.
• Initiate scar mobilization at 4 weeks.

Weeks 6 - 8

Manual

• Continue soft tissue mobilization, joint mobilizations, and scar mobilizations as needed to gain full range of motion.

Exercises

• 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.

Goals

• Range of motion 0-130 degrees.

Weeks 8 - 12

• Progression of program of increasing intensity to sport-specific tasks and activities of daily living.
• Continue to challenge balance; progress to increased dynamic tasks, BOSU ball, wobble board.
• Progress single-leg activities.

Goals

• Full range of motion.
• Able to descend stairs, double leg squat hold for >1 minute.
• Bike >30 minutes with moderate resistance, Elliptical with interval training, Flutter-style for swimming (no flippers, no breast-stroke kick).
• Initiate sport specific training.

Weeks 12+

• Incorporate bilateral jumping exercises once able to demonstrate adequate strength- start on trampoline or Pilates jump board. Watch for compensatory patterns with take-offs or landings.
• Complete Sports test 1 at 3 months.
• Continue to increase strength, endurance, balance, and sport-specific training drills.
• Patients are not scheduled for another M.D. appointment until 3 - 4 months post-op. At this time, range of motion should be at or near 100 % and any restrictions or concerns should be communicated to our office.

Goals

• Swimming (no fins until > 12 weeks), outdoor cycling.
• Slow Return to sports > 6 months if approved by MD and completion of Sports Test.

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.