ACL RECONSTRUCTION – PHYSICAL THERAPY PROTOCOL
Once or twice per week in weeks 1 and 2
Two or three times per week in weeks 3 to 11
Once or twice per week in weeks 12-16
Please send progress notes
Days 0 to 4
- Crutch-assisted partial weight bearing with knee brace locked in full extension
- Cryotherapy (20 minutes each hour)
- Patella mobilization
- Hamstrings and calf stretching
- Hourly ankle pumps
Range of motion exercises – 4 times daily
- Sitting with leg over edge and bend using non-operative leg to assist (5 minutes)
- Prone hangs (5 minutes)
- Heel Props: leg straight with heel propped up on towels to keep calf off the table (5 minutes)
Strengthening Exercises – twice daily (1 set of 10 repetitions on day 1; progress to 3-5 sets of 10 repetitions on day 2)
- Four-way straight leg raises
- Prone hamstring curls
- Quad sets (10 repetitions per hour)
Days 5 to 7
- Continue exercises as outlined above
- Weight bearing as tolerated with brace in full extension
- Weight shifts
- Mini squats as tolerated
Week 2
- Increase activity if pain and swelling controlled
- Elevate leg as much as possible
- Continue exercises as outlined above
- Four-way straight leg raises with additional weight as needed (weight placed above knee for supine leg raises)
- Leg press
- Stationary bike
- Hamstrings curls with weights, progressing to standing position
Week 3
- Continue exercises as outlined above
- 90-to-60 degree knee extensions
- Calf raises and lateral step-ups
- Closed-chain TKE’s with tubing
- Gait training exercises, such as agility ladder and cones
Weeks 4 and 5
- Continue exercises as outlined above
- Forward walking on treadmill
- Swimming with no whip kick, no pushing off walls, and no jumping into the pool. Pool walking is encouraged.
- Calf raises with weight (progress to unilateral raises)
- Simple balance activities, such as stork stands, KAT, BAPS
Weeks 6 to 8
- Continue exercises as outlined above
- Mini squats with weight or sport cord
- Lunges and single-leg squats
- Backward walking on treadmill
- Balance program, including balance beam, kicks, and/or toss
- Aerobic conditioning, such as stair climber, stationary bicycle, aquatic therapy, elliptical trainer, arc trainer
Weeks 9 to 11
- Continue exercises as outlined above
- Increased strengthening with slide board and low-weight, high-repetition knee extensions (from 90-to-30 degrees) on weight machine
Weeks 12 to 15
- Continue exercises as outlined above
- Isokinetic trials at 180 and 300 degrees/sec from 90 to 30 degrees
- Jogging program
Months 4 to 6
- Bilateral isokinetic evaluation at 180 and 300 degrees/sec throughout full arc of motion (If quads are 70% of non-operative leg, begin functional activity progression)
- Plyometrics and agility drills
Criteria for return to sport training:
- Satisfactory isokinetic testing results
- IKDC > 70
- Satisfactory clinical examination:
- Front step down
- Front jump down
- Single leg squat
- Single leg hop test for distance
- Cross over hop test for distance
Return to sport exercises:
Stage I: dynamic stabilization (core strengthening, single limb postural balance, etc)
Stage II: functional strength (lower extremity non WB strength, single limb force attenuation, etc.)
Stage III: power development (single limb power, fatigue resistance, etc.)