Anterior Cruciate Ligament Reconstruction
Anterior Cruciate Ligament Reconstruction
Hamstring Graft/PTG-Accelerated Rehab
This rehabilitation protocol has been designed for patients with ACL reconstruction who
anticipate returning to a high level of activity early postoperatively. The ACL
Rehabilitation protocol for all 3 grafts is the same with the following exceptions:
1. When performing heel slides, make sure that a towel/sheet is used to avoid
actively contacting the hamstrings.
2. Do not perform isolated hamstring exercises until the 4th week post-op.
The following are exclusionary criteria for this protocol:
• Concomitant meniscal repair
• Concomitant ligament reconstruction
• Concomitant patellofemoral realignment procedure
• ACL revision reconstruction
• MRI evidence of severe bone bruising or articular cartilage damage noted
The protocol is divided into several phases according to postoperative weeks and each
phase has anticipated goals for the individual patient to reach. The overall goals of the
reconstruction and the rehabilitation are to:
• Control joint pain, swelling, hemarthrosis
• Regain normal knee range of motion
• Regain a normal gait pattern and neuromuscular stability for ambulation
• Regain normal lower extremity strength
• Regain normal proprioception, balance, and coordination for daily
activities
• Achieve the level of function based on the orthopedic and patient goals
The physical therapy is to begin 2nd day post-op. It is extremely important for the
supervised rehabilitation to be supplemented by a home fitness program where the patient
performs the given exercises at home or at a gym facility.
Important post-op signs to monitor:
• Swelling of the knee of surrounding soft tissue
• Abnormal pain response, hypersensitive
• Abnormal gait pattern, with or without assistive device
• Limited range of motion
• Weakness in the lower extremity musculature (quadriceps, hamstring)
• Insufficient lower extremity flexibility
Return to activity requires both time and clinic evaluation. To safely and most
efficiently return to normal of high level functional activity, the patient requires adequate
strength, flexibility, and endurance. Isokinetic testing and functional evaluation are both
methods of evaluating a patient’s readiness to return to activity.
Dr. Matthew Crawford
Phase 1: Week 1-2
HS/PTG Accelerated Protocol
WEEK
1-2
EXERCISE
GOAL
ROM
0-1100
Passive, 0-1100
Patella mobs
Ankle pumps
Gastoc-soleus stretches
Wall slides
Hell slides with towel
STRENGTH
Quad sets x 10 minutes
SLR (flex, abd, add)
Multi-hip machine (flex, abd, add)
Leg Press (90-200)-bilateral
Mini squats (0-450)
Multi-angle isometrics (90-600)
Calf Raises
BALANCE TRAINING
Weight shifts (side/side, fwd-bkwd)
Single leg balance
Plyotoss
WEIGHT BEARING
Wt bearing as tolerated with crutches
Crutches until quad control is gained
One crutch before FWB with no crutches
BICYCLE
May begin when 1100 flex is reached
DO NOT use bike to increase flexion
MODALITIES
Electrical stimulation as needed
Ice 15-20 minutes with knee at 00 ext
BRACE
Remove brace to perform ROM activities
I-ROM when walking with crutches
GOALS OF PHASE:
• ROM 0-1100
• Adequate quad contraction
• Control pain, inflammation, and effusion
• PWB to FWB as capable
Dr. Matthew Crawford
Phase 2: Week 2-4
HS/PTG Accelerated Protocol
WEEK
2-4
EXERCISE
ROM
Passive, 0-1250
Patella mobs
Ankle pumps
Gastoc-soleus stretch
Light hamstring stretch at wk 4
Wall, hell slides to reach goal
STRENGTH
Quad sets with biofeedback
SLR in 4 phases (add ext at wk 4)
Heel raise/Toe raise
Leg Press
Mini squat (0-450)
Front and Side Lunges
Multi-hip machine in 4 directions
Bicycle/EFX
Wall squats
BALANCE TRAINING
Balance board/2 legged
Cup walking/hesitation walk
Single leg balance
Plyotoss
WEIGHT BEARING
As tolerated with quad control
MODALITIES
E-stim/biofeedback as needed
Ice 15-20 minutes
BRACE
Will measure for functional
Brace week 3-4
GOALS OF PHASE:
• Maintain full passive knee extension
• Gradually increase knee flexion to 1250
• Diminish pain, inflammation, and effusion
• Muscular strengthening and endurance
• Restore proprioception
• Patellar mobility
GOAL
0-1250
Discharge
Crutches
10 days post-op
Discharge
week 4
Dr. Matthew Crawford
Phase 3: Week 4-12
HS/PTG Accelerated Protocol
WEEK
4-8
EXERCISE
GOAL
ROM
Full ROM
Self-ROM tor gain FROM
0-1350
0
And maintain 0 extension
Gastoc/soleus stretching
Hamstring stretching
STRENGTH
Progress isometric program
SLR with ankle weight/tubing
Leg Press-single leg eccentric
Initiate isolated hamstring curls
Multi-hip in 4 planes
Lateral/Forward step-ups/downs
Lateral Lunges
Wall Squats
Vertical Squats
Heel raises/Toe raise
Bicycle/EFX
Retro Treadmill
Mini-squats/Wall squats
Straight-leg dead lifts
Stool crawl
BALANCE TRAINING
Steam boats in 4 planes
Single leg stance with plyotoss
Wobble board balance work-single leg
½ Foam roller work
MODALITIES
Ice 15-20 minutes following activity
BRACE
Functional brace as needed
8-10 ROM
Full ROM
Self-ROM as needed
0-1350
Gastroc/Soleus/HS stretch
STRENGTH
Continue exercises from wk 4-6
Progress into jogging program as ROM
Normalizes, pain and swelling are minimal.
Begin n mini-tramp, progress to treadmill as tolerated
Then hard surface when tolerated.
Progress with proprioception training
Isokinetic work (90-400) (120-2400/sec)
8-10 cont
Walking program
Bicycle for endurance
Plyometric leg press/shuttle work
10-12
ROM
Gastroc/Soleus/HS stretch
STRENGTH
Continue exercises from wk 4-10
Isokinetic test at 180 and 3000/sec
Plyometric training drills
Continue with stretching
MODALITIES
Ice 15-20 minutes as needed
GOALS OF PHASE:
• Restore full knee ROM (0-1350)
• Increase lower extremity strength and endurance
• Restore functional capability and confidence
• Enhance proprioception, balance, and neuromuscular control
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