ACL Reconstruction Accelerated Rehabilitation

16-03-16_Physical-Therapy-Rehabilitation

Accelerated Rehabilitation Protocol

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 grafts is the same with the following exceptions:
If a hamstring autograft was used:

  • when performing heel slides, make sure that a towel/sheet is used to avoid actively contracting the hamstrings.
  • do not perform isolated hamstring exercises until the 4th week post- op.

The following are exclusionary criteria for this protocol:

  • Concomitant meniscal repair
  • Concomitant reconstruction of another ligament
  • 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 after the 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 or 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 or 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.

Download PDF

Rehabilitation Protocols

Phase 1: Week 1-2 ACL Accelerated Protocol

1ROM

  • Passive, 0-110°
  • Patella mobilizations
  • Ankle pumps
  • Gastoc-soleus stretches
  • Wall slides
  • Heel slides with towel

2STRENGTH

  • Quad sets x 10 minutes
  • SLR (flex, abd, add)
  • >Multi-hip machine (flex, abd, add)
  • Leg Press (90-20°)-bilateral
  • Mini squats (0-45°)
  • Multi-angle isometrics (90-60°)
  • Calf Raises

3BALANCE TRAINING

  • Weight shifts (side/side, fwd/bkwd)
  • Single leg balance
  • Plyotoss

4WEIGHT BEARING

  • Wt bearing as tolerated with crutches
  • Crutches until quad control is gained
  • One crutch before FWB with no crutches

5BICYCLE

  • May begin when 110° flex is reached
  • DO NOT use bike to increase flexion

6MODALITIES

  • Electrical stimulation as needed
  • Ice 15-20 minutes with knee at 0° ext

7BRACE

  • Remove brace to perform ROM activities
  • I-ROM when walking with crutches

GOALS OF PHASE:

  • ROM 0-110°
  • Adequate quad contraction
  • Control pain, inflammation, and effusion
  • PWB TO FWB as capable

Phase 2: Week 2-4 ACL Accelerated Protocol

1ROM

  • Passive, 0-125°
  • Patella mobilizations
  • Ankle pumps
  • Gastoc-soleus stretch
  • Light hamstring stretch at wk 4
  • Wall, heel slides to reach goal

2STRENGTH

  • Quad sets with biofeedback
  • SLR in 4 planes (add ext at wk 4)
  • Heel raise/Toe raise
  • Leg Press
  • Mini squat (0-45°)
  • Front and Side Lunges
  • Multi-hip machine in 4 directions
  • Bicycle/recumbent bicycle
  • Wall squats

3BALANCE TRAINING

  • Balance board/2 legged
  • Cup walking/hesitation walk
  • Single leg balance
  • Plyotoss

4WEIGHT BEARING

  • As tolerated with quad control

5BRACE

  • Discontinue post-op brace week 4
  • Will measure for functional brace

6MODALITIES

  • E-stim/biofeedback as needed
  • Ice 15-20 minutes

GOALS OF PHASE:

  • Maintain full passive knee extension
  • Gradually increase knee flexion to 125°
  • Diminish pain, inflammation, and effusion
  • Muscular strengthening and endurance
  • Restore proprioception
  • Patellar mobility

Phase 3: Week 4-8 ACL Accelerated Protocol

1ROM

  • Self-ROM to gain Full ROM 0-135°
  • And maintain 0° extension
  • Gastoc/soleus stretching
  • Hamstring stretching

2STRENGTH

  • 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 raise/Toe raise
  • Bicycle/recumbent bicycle
  • Retro Treadmill
  • Mini-squats/Wall squats
  • Straight-leg dead lifts
  • Stool crawl

3BALANCE TRAINING

  • Steam boats in 4 planes
  • Single leg stance with plyotoss
  • Wobble board balance work-single leg
  • ½ Foam roller work

4MODALITIES

  • Ice 15-20 minutes following activity

5BRACE

  • Functional brace as needed

Phase 3: Week 8-10 ACL Accelerated Protocol

1ROM

  • Self-ROM as needed 0-135°
  • Gastroc/Soleus/HS stretch

2STRENGTH

  • Continue exercises from wk 4-6
  • Progress into jogging program as ROM normalizes, pain and swelling are minimal
  • Begin on mini-tramp, progress to treadmill as tolerated then hard surface when tolerated.
  • Progress with proprioception training
  • Isokinetic work (90-40°)(120-240°/sec)
  • Walking program
  • Bicycle for endurance
  • Plyometric leg press/shuttle work

Phase 3: Week 10-12 ACL Accelerated Protocol

1ROM

  • Gastroc/Soleus/HS stretch

2STRENGTH

  • Continue exercises from wk 4-10
  • Isokinetic test at 180 and 300°/sec
  • Plyometric training drills
  • Continue with stretching

3MODALITIES

  • Ice 15-20 minutes as needed

GOALS OF PHASE:

  • Restore full knee ROM (0-135°)
  • Increase lower extremity strength and endurance
  • Restore functional capability and confidence
  • Enhance proprioception, balance, and neuromuscular control

Phase 4: Week 12-16 ACL Accelerated Protocol

1ROM

  • Continue all stretching activities

2STRENGTH

  • Continue all exercises from previous phases
  • Progress plyometric drills
  • Increase jogging/running program
  • Swimming (kicking)
  • Backward running

3FUNCTIONAL PROGRAM

  • Sport specific drills

4CUTTING PROGRAM

  • Lateral movement
  • Carioca, figure 8’s

5MODALITIES

  • Ice 15-20 minutes as needed

GOALS OF PHASE:

  • Maintain muscular strength and endurance
  • Enhance neuromuscular control
  • Progress skill training
  • Perform selected sport-specific activity

Phase 5: Week 16-36 ACL Accelerated Protocol

1ROM

  • Continue advanced strengthening

2FUNCTIONAL PROGRAM

  • Progress running/swimming program
  • Progress plyometric program
  • Progress sport training program
  • Progress neuromuscular program

3MODALITIES

  • Ice 15-20 minutes as needed

GOALS OF PHASE:

  • Return to unrestricted sporting activity
  • Achieve maximal strength and endurance
  • Progress independent skill training
  • Normalize neuromuscular control drills

At six and twelve months, a follow-up isokinetic test is suggested to guarantee maintenance of strength and endurance. Advanced weight training and sports specific drills are advised to maintain a higher level of competition.

Schedule an Appointment

For more information or to schedule an appointment with one of our specialists, contact us today. For your convenience, you may also fill out the form to the right to set up an appointment.