ACL Post-Operative Rehabilitation
Dr. Carey Winder
Baton Rouge Orthopaedic Clinic
ACL protocol is the same as bone patellar tendon bone except for the following:
1. When performing heel slides, make sure that a towel is used to avoid activating the hamstring muscles
2. Do not perform isolated hamstring exercises for 6 weeks
3. Partial weight bearing with crutches for 4 weeks
- Patient begins physical therapy 3-5 days post-op
- Initial therapy treatment consists of the following:
- EMS/bio feedback to quads
- Quad setting for 10 minutes
- SLRs for 5 min
- HSS sitting in chair (30 sec hold, 5 reps)
- Calf stretching against wall (30 sec hold, 5 reps)
- Patellar mobilization (emphasize superior glides)
- 90-40 open chain manual resistance
- ROM Passive: progress as tolerated (DO NOT MANUALLY FORCE ROM!)
To increase flexion:
May perform heel slides, wall slides, or chair flexions (wall slides preferred for hamstring grafted patients)
To increase extension:
May perform HSS, calf stretches, prone extensions (use biofeedback to relax the
hamstrings or manually teach relaxation of the hamstring during prone stretch)
- Weight bearing as tolerated with crutches.
- Continue use of crutches until gains quad control (3-6 weeks), then go to one
crutch before FWB with no assistive devices
- May begin stationary cycling when can flex to 110 degrees (DO NOT USE STATIONARY BIKE TO INCREASE FLEXION!)
- Knee immobilizer when walking with crutches
- Will fit with a functional brace in the office. Wear the brace when ambulating to help protect from hyperextension injuries
- Continue above exercises
- Begin leg press from 90 to 20 degrees both legs.
- Progress to single leg press, stopping at 40, 60, and 90 degrees. When
stopping hold position for 5 seconds.
- We measure for a functional brace such as the DonJoy Defiance at 3-6 weeks post-op:
- We use the brace to protect the patient from possible hyperextension injuries.
- Utilize the K.A.T. for balance, “stork” single leg balance with knee flexed to 20-30 degrees. Addition of biofeedback to enhance the VMO contraction is helpful. Use of sports cord may be instituted as long as patient has good quad control.
- Pool Walking Okay – make sure patient realizes to walk only and not to perform whip kick
- Lateral step ups
- Progress with proprioceptive training
- May begin running at 8-12 weeks when ROM normalizes and pain and swelling allow.
- Start on trampoline, progress as tolerated to cushioned surface, then hard surface.
- At 180 and 300 degrees per second at 12 weeks.
- Include results in report to M.D.
- Continue with above and may add partial squats, forward lunges with straight bar.
- Progress as tolerated.
- Do not perform if patient has patellar femoral symptoms!
- Begin sport specific drills
- Return to activity based on KT-1000 scores and full ROM, Biodex test, and functional tests.