ACL Post-Operative Rehabilitation

ACL Hamstring Tendon Graft 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

Week 1:
- 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:
  • 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
Week 2 to 6:
- 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.
Begin proprioceptive training:
  • 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
Weeks 6-12:
  • 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.
Isokinetic test:
  • At 180 and 300 degrees per second at 12 weeks.

  • Include results in report to M.D.
3 to 6 months:
  • 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!
6 to 12 months:
  • Begin sport specific drills

  • Return to activity based on KT-1000 scores and full ROM, Biodex test, and functional tests.