ACL Reconstruction Rehab Protocol

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Phase 1 (0-6 weeks)

  • Goals: Control swelling, activate quadriceps, restore neuromuscular communication, prevent kinesiophobia
  • Gait training
  • Modalities: Compressive cyrotherapy, e-stimulation
  • Weight bearing:
    • As tolerated with crutches, unless:

* Non-weight bearing x 6 weeks for ACL Revision surgery.

* Non-weight bearing x 6 weeks with meniscal repair or cartilage restoration. Defer to these attached protocols for weight bearing, ROM and bracing guidance.

* Non-weight bearing x 6 weeks in cases of multi-ligamentous knee (+/- PCL/MCL/PLC)

  • Brace:
    • 0-6wks
  • ROM:
    • Locked in extension for initial 48 hours.
    • 0-4wk: Passive 0-90 degrees
    • 4-6wk: Advance to full ROM 0-120 degrees
  • Exercises: Heel slides, quadriceps / hamstring sets, patellar mobilizations, gastroc/soleus stretches; SLR in full extension until quad strength prevents extension lag

Phase 2 (6-12 weeks)

  • Weight bearing: Full progression to normal gait pattern
  • Brace: Discontinue at 6 weeks postoperatively
  • ROM: Maintain full extension and progress flexion to full
  • Exercises: Progress from Phase 1: Begin toe raises, closed chain quads, balance exercises, hamstring curls, stationary bike, step-ups, front and side planks, hip/gluteal/core, pool

Phase 3 (12-16 weeks)

  • Weight bearing: Full, without use of crutches and with a normalized gait pattern
  • Brace: None
  • ROM: Gain full and pain-free
  • Exercises: Advance closed chain strengthening, progress proprioception activities. Begin Stairmaster, elliptical.