York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

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:

  1. Satisfactory isokinetic testing results
  2. IKDC > 70
  3. 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.)