ACL Reconstruction Rehab Protocol

Week 0-6:

1st postop visit 10-14 days postop – wound check – no sutures or staples to take out – all are dissolvable.  usually we get PT setup now if patients are ‘guarding’ their knee.

1. Aggressive swelling management: ICE, ELEVATION, NSAID therapy.

2. No resistance exercises.  Active ROM only: walking, stationary bike, bending and straightening.

3. Ween crutches when not limping.

2nd postop visit 5-6 weeks postop – check progress with Range Of Motion (ROM).  Goal for 6-8 weeks postop is to have near full ROM.  Start formal PT if none started for CLOSED CHAIN RESISTANCE ONLY.

After Week 6:  

Closed chain resistance exercises only.  ie stationary bike with resistance, squats, leg presses.  CLOSED CHAIN means your feet stay attached to a pedal/plate/ground.  OPEN CHAIN is running or a lunge etc where feet leave the the closed circuit/chain.

Until Objective Quad strength measures 90% of contralateral leg – needs to be objectively measured ie how many single leg squats or single leg presses is the non-operative “good” leg able to do compared to the operative  leg….no open chain until 90%.

3rd/possible final postop visit – reassess PT progress.  Confirm/re-educate on objective measure of strength and timeframes for return to sport

IF Objective quad strength >90% contralateral leg, ok to progress to open chain exercise, ie running.  this may be 3-9 months postop.

NO lateralized/cutting/sports until 9-12 months postop AND quad strength recovered 100%.  “Ligamentization” takes 9-16 months – you cannot rush the graft incorporation.

 

*** ACL Reconstruction is one of the most studied/published subjects in orthopedic surgery.  There are many techniques for the surgery itself and many protocols for recovery.  ***