ACL Rehabilitation Protocol
Peter Dewire, M.D.
I.
Immediate Post-Op
- Bledsoe brace locked at 0
- Cryocuff incorporated in brace with TED
stocking
- Patent instructed in performance of ROM
exercises:
2-3X/daily
1. “Towel” extensions: obtain passive extension
at least 30 minutes by propping heel up on
pillows.
2. Passive flexion- off side of bed.
3. Good leg assist for passive ROM out of
brace.
4. Prone extension stretch.
- Isometric hamstrings
- Isometric quads at > 45 degrees. Quad sets,
SLR at 0 degrees.
- SLR for quad control
- Contractions
- Ankle Pumps
- Weight-bearing as tolerated with crutches
(except meniscal repair)
- Meniscal Repairs:
1. Nonweight-bearing for 4 to 6 weeks.
2. Limit flexion to 90 degrees for the first
4 weeks.
II.
Days 3-4 to 2-3 Weeks
- CPM for home use (2hrs, 3X/day at slow speed
for 2 weeks). Progressive increase in
increments of flexion. Start at 40 degrees.
Increase 10 degrees per day up to 90 degrees,
then increase in 5-degree increments as
tolerated. (Remove brace for CPM and
exercise).
- Goal: 0-100 degrees of flexion (emphasis on
full extension)
- Out patient physical therapy: 3X/Week
- Use TED stocking until follow-up appointment
(10-14 days)
- Continue use of Cryocuff as needed
- Home exercises: 3X/Week:
ACL Protocol Cont.
Page Two
1. Towel extensions
2. Prone passive stretching (if necessary
for extension)
3. Wall and heel slides for flexion (or
comparable flexion exercises)
4. Active assisted knee flexion only
5. Good leg assist passive extension
6. Isotonic hamstrings
7. Open chain quads 90-45 degrees (if
tolerated)
III. Weeks 3-6
- Wean down to one crutch or cane (Exception:
Meniscal Repairs)
- EMS Protocol
- Continue ROM exercises as before with home
program
- Water conditioning (if available)
- Swimming- (weel leg kick only)
- Stationary biking, Stairmaster, ¼ squats
- Start easy closed chain quad exercises
- Isotonic hamstrings
- Quads 90-30 degrees (if no patellar irritation)
- Stress full extension. Should have 120 degrees
of flexion by 6 weeks
IV.
Weeks 6-12
- Most strengthening exercises for quadriceps are
to be closed kinetic chain exercises.
1. Bilateral knee bends progress to
unilateral knee bands
2. Calf raises (double  single leg)
3. Leg press machine (90-10 degrees)
4. One leg balancing
- Brace for high risk situations only
- Wean off crutch or cane
- Stationary bike (for ROM first, then gradually
add resistance)
- Continue heels slides for flexion at home
- Passive flexion stretch
- Water conditioning
- Swimming (flutter kick only)
ACL Protocol Cont.
Page Three
-
V.
VI.
Increase hamstrings
Stretching
If quad strength > 70%- rope jumping (with
brace), leg press, hip side, squat rack (90-10
degrees), Stairmaster
3-5 Months
- Cycling and swimming (progress to road bike)
- Isokinetic’s at 5-6 months with Extension Stop
of 20 degrees (NO LOW ANGULAR VELOCITIES)
- Jogging at 3-4 months (if quad strength > 70%)
- Proprieceptive Exercises (balance board)
- Leg press
- Strength Test, KT-1000. If .70% strength,
lateral shuffles, cariocas, jumping rope,
isotonics with 20 degree extension stop.
- Closed cahin quad strengthening with increasing
resistance.
5-12 Months
- Progressive strengthening without resistance on
extension.
- Propriceptive exercises
- Sports specific activities
- Biking and Swimming
- Return to all sports (per physicians
instructions)
- Running sports Cutting sports
- Jumping sports last
- Serial isokinetic testing as indicated
- Running program with emphasis on agility and
power
- Functional activities
1. Side-cutting
2. Back pedaling
3. Cutting
4. Pliometrics