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Knee & Shoulder Doctor

Delayed Rehabilitation Protocol Following ACL Reconstruction

The delayed rehabilitation protocol is utilized for ACL reconstruction with meniscal repair, other ligament reconstruction, realignment procedures, revision settings and cartilage repair/restoration.

The purpose of this protocol is to provide the physicians, therapists, and other care providers with a guideline of the post-operative rehabilitation course. This rehabilitation protocol has been formulated for ACL reconstruction patients with BTB autograft or allograft, hamstring autograft or allograft, and Achilles tendon allograft.

Goals of ACL reconstruction

Diminish inflammation, pain and swelling
Obtain normal knee range of motion (focus on knee extension)
Regain voluntary muscle activation
Obtain normal proprioception, balance and coordination for daily activities
Return to sport

During your postoperative course, it is imperative to be mindful of:

Persistent swelling
Abnormal pain or hypersensitivity
Limited range of motion
Weakness of quadriceps
Avoid active hamstring exercises until sixth week postop

Return to sport/activity

This is dependent on time and clinical progression. Full return to activity requires good strength, flexibility and endurance. These can be tested with multiple clinical and physical therapy parameters.

 

Phase 1 (Weeks 1-3)

Goals

  • Diminish knee effusion, pain and inflammation ROM dependent on procedure performed (PASSIVE ONLY):
    • 0-90 degrees ROM for meniscal repairs, ACL revision, multi-ligament reconstruction and most cartilage repair/restoration
    • 0-75 for realignment procedures
    • Obtain good quad contraction, perform ankle pump exercises
    • Patellar mobilization


Strength and Exercises

  • SLR in flexion, abduction and adduction
  • Quad sets
  • Calf stretches
  • Wall and heel slides


Weight Bearing

  • Meniscal repair: NWB
  • ACL revision, multiligament recon, cartilage procedures: per Dr. Shah


Modalities

  • Cryotherapy
  • Elevate leg in full extension
  • Electrical stimulation


Brace

  • May remove for exercises
  • Must use when ambulating

 

Phase II (Weeks 3-5)

Goals

  • PASSIVE ROM ONLY: 0-90 degrees
  • Obtain good quad contraction, perform ankle pump exercises
  • Patellar mobilization


Strength and Exercises

  • Continue SLR in flexion, abduction, adduction.
  • Quad sets
  • Leg press
  • Low flexion squats, wall squats
  • Start multi angle isometrics at 90 and 60 degrees of extension
  • Sitting calf raises, calf stretches
  • Wall squats


Weight Bearing

  • Meniscal repair: NWB
  • ACL Revision, multiligament recon, cartilage procedures: per Dr. Shah


Modalities

  • Cryotherapy
  • Elevate leg in full extension
  • Electrical stimulation with biofeedback


Brace

  • May remove for exercises
  • Must use when ambulating

 

Phase III (Weeks 5-12)

Goals

  • Passive ROM: 0-125 degrees, progress to 140 degrees by week 10


Strength and Exercises

  • Continue SLR in flexion, abduction, adduction, extension with weights
  • Leg press – bilateral leg eccentric, single leg can start at week 10
  • Start gentle isolated hamstring curls at week 6
  • Low flexion squats, wall squats
  • Start lunge program
  • Progress multi angle isometrics program
  • Start stationary bike program when 110 degrees achieved
  • Walking program starting at week 8-10


Weight Bearing

  • Meniscal repair: progress to PWB at week 6, then to FWB by week 10 Other procedures: progress to FWB per Dr. Shah


Balance Training

  • Single leg stance and weight shift
  • Balance board, foam roller board
  • Proprioceptive exercises


Modalities

  • Electrical stimulation with biofeedback

 

Phase IV (Weeks 12-16)

Goals

  • Maintain full knee ROM
  • Maintain strength and endurance
  • Improve neuromuscular control
  • Continue skill training


Strength and Exercises

  • Continue Phase 3 exercises
  • Progress plyometric drills
  • Start jogging at week 16
  • May start swimming (kicking)
  • Backward running


Functional Training

  • Start sport specific drills at week 16
  • Gentle cutting program and lateral movements
  • Figure 8s


Balance Training

  • Balance board, foam roller board
  • Proprioceptive exercises

 

Phase V (Weeks 16-36)

Goals

  • Return to sporting activity
    • Autografts at 6 months, Allografts at 9 months
    • Achieve maximum strength and endurance


Strength and Exercises

  • Continue advanced training


Functional and Balance Training

  • Progress running and swimming program
  • Start sports metric program:
    • Autografts at week 20
    • Allografts at week 24
  • Progress neuromuscular training program
  • Single leg hop test (80% of contralateral extremity)

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