ACL Reconstruction Rehabilitation Protocol

Weeks 0-2

Goals

Pain & post-operative swelling management

To establish 0-90° range of motion (Full extension priority!)

Patient education regarding gait, balance and wound management

ROM (Range of motion)

Exercise to establish a range 0-90° with the aid of heel slides.

Calf & hamstring passive stretches

Exercise bike (slow cycles and low resistance)

Muscles

Isometric and eccentric hip flexion, extension and abduction (both standing and lying down)

Static and Inner range quadriceps exercises (cushion under thigh, extend knee).

Standing single & double heel raises (this can be done with or without support)

Static and co-contraction (with quadriceps)

Mini wall squats (up to 30°).

Quadriceps

Static and co-contraction (with quadriceps)

Static lunges

Sit to stand

Hamstrings

Gluteals

Calves

Proprioception

Single leg stance for 30 to 60 seconds

Gait

Start full-weight bearing with 2 crutches (progress to one crutch until patient has normal gait with 1)

Weight-shifting exercises (side-to-side & forward-and –backward)

Modalities

Ice packsfor 20-30 minutes at a time (allow 2-3 hours in between)

Analgesics(Paracetamol, NSAIDs)

Muscle stimulation

Week 2 – Week 6

Goals

Progress to full knee flexion and extension

Achieve normal gait pattern

Strength opposite limb

Progress with proprioception

ROM (Range of motion)

Exercise to establish a range 0-90° with the aid of heel slides.

Standing calf and hamstring stretches

Assisted quadriceps stretching exercises (standing)

Heel slides and exercise bike (allow full circles forward & backward)

Muscles

Hip strengthening all directions (with ankle weight). Both concentric & eccentric exercises.

Forward & Lateral step-ups (ensure body weight passes through heel)

Assisted squats with increasing range and resistance as tolerated.

Commence leg press machine (allow a maximum of 70% body weight)

Bridging lying supine on the floor with legs on a Swiss ball

Progress to single heel raises (with or without support)

Prone assisted hamstrings (use opposite limb)

Wall squats (allow maximum of 60°)

Quadriceps

Hamstrings

Gluteals

Calves

Proprioception

Double/single leg stance (with eyes forward, looking away and closed)

Gait

Progress to unassisted full weight bearing

Exaggerate hip and knee flexion during swing phase of gait

Cardiovascular

Exercise bike

Start elliptical trainer

Week 6 – Week 9

Goals

To achieve full, pain free range of motion

Begin limited/specific isokinetic quadriceps exercises

ROM (Range of motion)

Achieve full knee flexion and extension

Continue hamstring and calf stretches

Muscles

Active low resistance hamstring curls in prone, standing and sitting positions

Advance on all direction strengthening (ankle weights, resistance cables)

Full & inner range squats with increasing resistance as tolerated

Eccentric lateral step downs (slow, controlled knee flexion)

Static lunges (all directions) progressing to dynamic lunges

Bridging (supine on the floor with legs on a Swiss Ball)

Initiate isokinetic quadriceps rehabilitation programme

Full wall squats (up to 90°).

Step – ups (up to 20cm)

Quadriceps

Hamstrings

Gluteals

Calves

Proprioception

Single leg stance on mini-trampoline

Upper body work (throwing)

Floor disc squatting & throwing

Wobble board (balance)

Gait

Hydrotherapy sessions: Knee ROM, walking (all directions), hip ROM

Cardiovascular

Exercise bike

Swimming(Flutter kick only)

Pool jogging(Paracetamol, NSAIDs)

Treadmill(Walking. Avoid jogging)

Week 9 – Week 12

Goals

Progressive quadriceps & hamstring strengthening, proprioception and flexibility

ROM (Range of motion)

Continue stretches as before ensuring achievement of full knee range of motion

Muscles

Hamstring curls (in the standing, sitting and prone position) with increasing resistance as tolerated

Low resistance jumping (2 legs, then jogging, then single leg hops)

Dynamic lunges ensuring proper truncal alignment

Progress with isokinetic programme

Eccentric hamstring rehabilitation

Eccentric step downs (20cm)

Quadriceps

Backward step-ups

Single leg squats

Hamstrings

Gluteals

Progress as before

Calves

Eccentric heel drops

Proprioception

Catching & throwing exercises on wobble boards & mini-trampoline

Single leg stance on a floor disc (kicking drills, upper body skills)

Cardiovascular

Exercise bike

Pool running(increasing time and repetitions)

Treadmill(incline walk and increase speed. Avoid jogging)

Week 12 – Week 16

Goals

Continue flexibility and strengthening of the lower chain

Commence sport specific quadriceps/hamstring strengthening, proprioception & cardio fitness

Muscles

Continue concentric & eccentric quadriceps and hamstring exercises

Backward lunge walking

Progress from jogging to running

Split squat jumps

Single leg drop landing (5cm)

Proprioception

Ladder drills (forwards/backwards/side-to-side)

Side step-overs (progressing to side step-overs)

Skipping and hopping (2 legs progressing to single leg)

Mini-trampoline (2 feet jumps – jogging – single leg jumps)

Continue single leg floor disc exercises (aim for sport specific activities. E.g.: kicking, hockey shot, cricket batting etc.)

Cardiovascular

Exercise bike

Pool hopping and squat jumping(in shallow water)

Treadmill jogging progressing to runningsport specific cardio training

Week 16 - Week 26

Goals

Sport specific lower chain strengthening and progress to plyometric exercises

Continue proprioceptive & cardiovascular fitness Muscles

Progress as before concentrating on specific deficits on muscle groups (if any arise)

Agility & Plyometrics

Progress on running/lunging/vertical jumps/run-stop-sidestep

Single leg drop landing (progressive up to 25cm)

Box hops/jump and forward sprints

Single leg forward & side hopping.

Ladder drills (all directions)

Single leg jumps

Proprioception

Progress on mini-trampoline

Forward & side hops (maintain 5 second single leg balance on landing)

Cutting drills (quick stop & balance)

Cardiovascular

Continue concentric & eccentric quadriceps and hamstring exercises

Backward lunge walking

Progress from jogging to running

Split squat jumps

Single leg drop landing (5cm)

6-9 Months

Goals

Adequate cardiovascular fitness, strength, power, agility neuromuscular control, symmetry and stability

Continue with upper body strengthening

Back to sport practice for upper skills (as able)

Return to sport skills on own at practice with minimal risk of re-injury

Exercise Suggestions

Single leg drop jump 6” step

Large Figure 8’s

Carioca running full speed

Last minute decision drills

2 and 1 foot hopping with control

Forward and lateral hop with control and comparable distance L&R

Triple jump and landing with control and comparable distances L&R

Single limb hop for distance (within 15% of uninvolved side) control and comparable distances L&R

Single-limb crossover triple hop for distance (within 15% of uninvolved side)

Single-limb timed hop over 6 m (within 15% of uninvolved side)

Single limb vertical power hop (within 15% of uninvolved side)

Single limb drop landing (within 15% of uninvolved side)

Single limb drop-jump

10 second single limb maximum vertical hop (both sides)

Return to sport

Most successful individuals return to sport after 8-10 months post-surgery, provided the knee is free from pain and swelling during functional training.

Adequate strength and endurance for the specific sport are necessary.

Return time varies individually, and concurrent injuries may delay the timeline. Surgeons will advise an appropriate return time based on progress. If you are under 18, the greatest risk factor for re-tear is considered, and most patients will remain off sport for 12 months.

Do you need a

Knee replacement?

Dr Seeto in affiliation with Medibank Private and East Sydney Private hospital, offers a program for eligible Medibank Private Members, to eliminate medical out of pocket costs for your Knee Replacement.

The program includes a pre-surgery preparation program, spending the minimal time necessary in hospital, as well as home rehabilitation if necessary.