The ACL Protocol is a guideline for patients and therapists to use for rehab after ACL reconstruction. These guidelines should not replace any directives provided to a patient by their surgeon or physician.
Anterior Cruciate Ligament Reconstruction Rehab Protocol
Note: WB, ROM, etc.. will be modified with meniscal repair
Meniscal repair only- 6 weeks, NWB
ACL with meniscus repair-TTWB 6 weeks then gradual increase WBAT
Immediate Post-op
Long leg brace locked in full extension (at all times except for exercises) for
5 weeks
Stretching: prone hang/towel extensions
ROM (out of brace) : 0-120 degrees
Strengthening: quad isometrics/ co-contractions, SLR (all planes, flexing hip as long as full knee extension maintained), hamstring curls (prone/standing), gluteal isometrics, ankle pumps, knee extension (90 to 60 degrees)/proximal resistance
Add EMS (first hams/then quads) until no quad leg with SLR
Week 3
Long leg brace locked in full extension (at all times except Bledsoe for exercises)
Stretching: prone hang/towel extensions, patellar mobilization (especially superior)
ROM (out of brace): 0-120 degrees
Strengthening: as above, add wall sites, (1/4 squats, sit to stand: 2 to 1 leg) progressive closed-chain activities, and toe raises, and DCEMS when able to do SLR without extensor leg
Continue EMS to quads as needed
Conditioning: stationary bike (low resistance with toe straps), treadmill (forward/retro), swimming may be implemented but no vigorous knee motion should be allowed
Week 5
Functional knee brace with exercise/sport if prescribed (for 12 months)
Stretching: prone hang/towel extensions (until full extension maintained, then discharge)
ROM (out of brace): 0-135/140 (full)
Strengthening: as above, but increase knee extension (90 to 30 degrees) proximal resistance, begin eccentric quad exercises and hamstring isokinetic, and add weights to hamstring curls and SLR as tolerated (above thigh)
Conditioning: as above, but increase stationary bike (progressive resistance)
Begin single leg stance exercises for balance/early proprioception
Week 7
Strengthening: discharge SLR, initiate Nautilus (hamstring, quad 90 to 30 degrees, leg presses)
Conditioning: ass StairMaster/cross country ski machine
Progress proprioceptive training (single limb balance and control)
Begin adding weight to closed chain exercises
Month 4
Strengthening: increase knee extension (full range)
Conditioning: Double hops-single hops-jogging/running (when walking without compensation and demonstrating eccentric control)
Agility/sport- specific training (with brace if indicated: add plyometric training, cariocas, cutting, figure of 8’s ,etc
When exhibiting good control with straight line movement
Add fitter/slide board
Strength testing: isokinetic evaluation
Month 6
Agility/sport- specific training
Strength testing: continue until torque/body weight goals are within 10%
Return to sport when:
Full ROM and no joint effusion
Isokinetic test indicates quadriceps strength is 80% or more and hamstring strength is 85% or more of uninvolved leg
Successful completion of running program and of sport-specific agility program
Satisfactory clinical exam and functional brace
SLS time is within 10% of opposite leg
